上海某三甲医院医疗纠纷影响因素研究

The Influence Factors of Medical Disputes in A Tertiary Hospital in Shanghai

目的通过对上海某三甲医院医疗纠纷案例进行分析,找出该院发生医疗纠纷原因,提出相应对策。方法调查该院158例医疗纠纷案例,采用单因素分析和Logistic回归分析法,对影响医疗纠纷等级的因素进行分析。结果医疗纠纷投诉成因主要有医方和患方两方面,医疗纠纷级别主要分布在三级(70.9%)和四级(29.1%)。患方因素包括患者的性别、籍贯、言语威胁医生、对医疗行为存在误解、住院时间;医方因素包括医生违反诊疗常规、诊治不及时、病情评估不充分、对突发事件处置经验不足、技术水平不高;疾病因素包括疾病分类和治疗效果,P值均小于0.05,差异具有统计学意义。医生对突发事件处置经验不足(P=0.002)、医生违反诊疗常规(P=0.004)、疾病的治疗效果(P=0.007),是造成医疗纠纷等级差异的原因。结论通过加强医务人员沟通能力及对突发事件处置的培训,建立健全医疗纠纷应急预案机制,建立有效的病例质量控制机制,提高医护人员临床业务水平和患者依从性,注重患者疾病治疗效果,可有效减少医疗纠纷的发生。

Objective By analyzing the medical disputes in a tertiary hospital in Shanghai,the causes of medical disputes were found out,the corresponding countermeasures were put forward.Methods The 158 cases of medical disputes were investigated,and the factors affecting the level of medical disputes were analyzed by using the single factor analysis and logistic regression analysis.Results The main causes of medical dispute complaints included two aspects of doctors and patients,and the level of medical disputes was mainly level 3(70.9%)and level 4(29.1%).The patient's factors included gender,native place,patient's speech threatening doctor,misunderstanding of medical behavior,and hospital stay.The doctor's factors included the violation of the diagnosis and treatment regulation,not in time diagnosis and treatment,inadequate condition evaluation,inadequate emergency handling experience,the low technical level.The disease factors included the treatment effect and the classification of diseases.The P-values were less than 0.05 with the differences were statistically significant.The reasons for the difference on the medical disputes level included inadequate experience of emergency handling(P=0.002),the violation of the diagnosis and treatment regulation(P=0.004)and the treatment effect of the disease(P=0.007).Conclusion Through strengthening the training of the communication ability and emergency handling,improving the mechanism of emergency planning for medical disputes,establishing effective medical records quality control mechanism,improving the clinical business level of medical professionals,improving the compliance of patients,and focusing on the treatment effect of patients,the occurrence of medical disputes can be effectively reduced.