分级过程管理策略对医疗安全建设的作用研究

Effect of hierachical process management program for construction of medical safety

目的研究分级过程管理策略对促进医疗安全建设的作用。方法该研究分成两组,2008年1月1日～12月31日实施分级过程管理策略前的医院医疗安全情况为基线组,2009年1月1日～12月31日实施该策略后的医疗安全状况为干预组,分析该策略对医院医疗安全系数、医疗差错和医疗纠纷发生率的影响。结果基线组和干预组在手术科室数、手术医生数、手术例次及总出院人次等方面具有可比性。该策略实施后,医院医疗安全系数(MSC)从(0.62±0.31)提高到(0.73±0.25)(P=0.007),医疗纠纷发生率从0.56%降低至0.33%(P=0.002),医疗差错发生率下降39.8%(P=0.000)。结论分级过程管理策略可提高医院医疗安全系数(MSC),降低医疗纠纷和医疗差错的发生率,这种低成本的管理策略可以成为医院医疗安全建设的重要组成部分。

[Objective ] To assess the effect of hierarchical process management program for the construction of medical safety in hospital. [Methods ] This study consisted of medical safety coefficient （MSC） evaluation of Shanghai Punan Hospital inpatients after the institution of hierarchical process management program （intervention group, between Jan. 1, 2009, and Dec. 31, 2009） and that immediately preceding institution of the program （baseline group, between Jan. 1, 2008, and Dec. 31, 2008）. The changes of MSC, the incidence of medical dispute, medical error between two groups were analyzed. [Results] The two groups were well matched, with same clinical departments and similar doctors performing operations, similar inpatient number who underwent operations and similar inpatient total. After institution of this program, MSC of the hospital increased from （0.62±0.31） to （0.73±0.25） （P=0.007）, the incidence of medical dispute decreased from 0.56% to 0.33% （P=0.002）, marked by a 39.8% reduction in the percentage of medical errors （P=0.000）. [Conclusion] This hierarchical process management program resulted in a significant increase in hospital MSC and was associated with decreased incidence of medicai dispute and medical error. These results support the adoption of this low-cost intervention program as an important part of management for hospital medical safety.