上海三级医院医疗事故鉴定的趋势分析与对策

The Tendency Analysis and Countermeasures on the Appraisal of the Medical Malpractices of the Tertiary Hospitals in Shanghai.

通过对上海市5所三级综合性医院1985年至1999年15年间医疗事故鉴定的发展趋势所作的回顾调查与比较分析(其中随机抽取45例医疗事故鉴定作原因分析),结果显示:(1)15年作一级事故鉴定数共295例,5年年均数29.8例,比前10年年均数上升51％。(2)15年定为事故与鉴定数的相关分析P>0.01,无显著差异;后5年两者比较P<0.01,有非常显著的差异。(3)15年门急诊总量6860万人次,与鉴定数逐年的相关分析P<0.01,有非常显著的差异,(4)随机抽样45例鉴定数显示:①手术科室、急诊室分别占73.33％、15.56％,死亡率为42.22％;②医院有不规范诊疗等7项医源性原因。结论:15年来医疗事故鉴定数呈上升趋势(后期5年尤为明显),它与定性事故数的多少无关,与医疗业务量增减无关。手术科室、急诊室是发生医疗纠纷的高危部门,其中重危病人是高危对象。医疗纠纷除医源性原因外,还有非医源性(社会、病人)原因。提出了加强管理,减少纠纷的6条对策。

Through the retrospective survey and comparative analysis on the development tendency of appraisal of medical malpractices in Shanghai's 5 tertiary comprehensive hospitals during 15 years from 1985 to 1999(among them, causes analysis of 45 medical malpractices selected by random sampling were made). Results show that(1) the total appraisal number of first - rank medical malpractice during 15years is 295 cases, the average number per year in the last 5 years is 29~8cases , which increases 51%compared with the first 10 years . (2) The correlative analysis between the appraised medical malpractices and the total appraisals has no statistic significance(P> 0.01); that in te last five years has remarkable statistic significance(P <0. 01) . (3) Tthe total emergencies of outpatient during 15 years is 6. 8 6 millions person - times, and the correlative analysis with the yearly appraisals has remarkable significance(P < 0. 01). (4) Results of th 45 medical malpractices selected by random sampling show that (a) medical malpractice of operating departments and emergency department account for 7 3. 33% and 15. 56% respectively, the death rate is 42. 22%; (b) hospitals exist 7 nosocomial causes including non -normative medical practice. Conclusion: the total medical malpractice appraisals has an increasing tendency in 15 years (especially remarkable in last 5 years ), and it has no correlation with the number of appraised medical malpractices and the total medical services. The operating and emergency departments are the dangerous department easy to take place medical issue, and the patients have serious disease are the dangerous objectives. Medical malpractice has non -medical causes(social and patient cause) except for the nosocomial causes. 6 counter-measures including enhancing management and decreasing malpractice have been put forward.