上海市闵行区456例发生理赔的医疗纠纷分析及管理对策

Analysis and countermeasures of 456 cases of claims for medical disputesin Shanghai Minhang District

目的:对上海市某区内医疗机构2002年至2014年发生的明确为医疗机构存在医疗过失责任,或在处理医患矛盾时被殴打致伤医务人员所发生医疗责任保险理赔的456例案例进行回顾性分析,旨在探讨纠纷发生因素并从区卫计委管理层面提出一些管理策略。方法:对456例发生理赔的案例按个案属性进行归类整理,按分布特征分类统计。结果:医疗纠纷发生特点为二级以上综合性医院为大多数,大多发生在内外科临床科室,其中手术科室比例最高,纠纷发生的责任主体以临床医师、护士为主。按照纠纷发生原因分析,主要为诊疗缺陷(27.41%)、病情评估不足(18.42%)、护理不当(14.69%)。结论:加强全面全程管理、加强医疗质量管理、建立良好医患沟通机制、完善医疗纠纷与解决机制、注重社会原因的影响是有效减少医疗纠纷的重要措施。

Objective： Retrospective analysis was done on456 cases of medical liability insurance occurred in medical institutions in Shanghai from 2002 to 2014 for medical personnel who had medical malpractice or who was beaten and injured during the period of dealing with the doctor-patient disputes. The aim was to explore the factors of the dispute and to put forward some management strategies from the District Health Commission management level . Methods： 456 cases of claims were classified according to the case attributes, and the distribution characteris- tics were classified. Results： The majority medical disputes occurred in second grade general hospitals, mostly in clinical department, especially the highest proportion of surgical departments. The main responsibility for the occur- rence of disputes are clinicians and nurses. According to the cause of the dispute analysis, mainly for the diagnosis and treatment of defects （27. 41%）, lack of assessment of the disease （18.42%）, Inappropriate care （14.69%） . Conclusion ： It is an important measure to reduce the medical dispute effectively by strengthening the comprehensive management, strengthening the medical quality management, establishing the good communication mechanism of doctors and patients, perfecting the medical dispute and resolving mechanism, and paying attention to the social rea- son.