从不良事件角度探析医疗纠纷的影响因素及防控策略

Influencing Factors and Prevention and Control Strategies of Medical Disputes from the Perspective of Adverse Events

目的从不良事件角度探析医疗纠纷的影响因素及防控策略,为医疗安全管理提供参考。方法抽取某三级综合医院近3年137例不良事件数据,使用SPSS 21.0统计软件分析不良事件分级、成因类型、发生环节、发生科室、当事医务人员性别、患方心理状态等因素对医疗纠纷发生情况的影响。结果137例不良事件中有34例发生医疗纠纷。不同级别不良事件的医疗纠纷发生率存在线性增长趋势(χ^(2)趋势=53.693,P=0.001),一级到三级不良事件较四级不良事件的医疗纠纷发生率更高(P<0.001)。医疗操作环节和诊疗技术引起的不良事件医疗纠纷发生率更高(P<0.05)。外科不良事件较内科不良事件发生医疗纠纷的概率更高(P=0.008)。与女性医务人员相比,涉及男性医务人员的不良事件发生医疗纠纷的概率更大(P=0.007)。不同心理状态的患方不良事件的医疗纠纷发生率存在线性增长趋势(χ^(2)趋势=5.085,P=0.024),患方偏执的不良事件发生医疗纠纷的概率更高(P=0.016)。结论医疗机构应重视高级别不良事件的预防和控制,并从提高医疗技术水平、加强外科科室质量安全管理、营造良好患者安全文化氛围、重视患方心理和社会属性的变化等方面来减少或避免医疗纠纷发生。

Objective To analyze the influencing factors and prevention and control strategies of medical disputes from the perspective of adverse events,so as to provide reference for medical safety management.Methods Data of 137 adverse events in a tertiary general hospital in recent 3 years were collected.SPSS 21.0 software was used to analyze the effects of adverse event classification,cause type,occurrence link,occurrence department,gender of the medical staff involved,psychological state of the patient and other factors on the occurrence of medical disputes.Results Among 137 adverse events,34 adverse events resulted in medical disputes.The incidence of disputes with different levels of adverse events showed a linear increasing trend(χ^(2) trend=53.693,P=0.001).The dispute rate of level 1 to Level 3 adverse events was higher than that of level 4 adverse events(P<0.001).Adverse events caused by medical operation links and diagnosis and treatment techniques had a higher incidence of medical disputes(P<0.05).Surgical adverse events had a higher probability of disputes than medical adverse events(P=0.008).Adverse events involving male medical staff was more likely to result in disputes than that of female medical staff(P=0.007).Adverse events of patients or family members with different mental states had a linear increase trend in the incidence of medical disputes(χ^(2) trend=5.085,P=0.024).Patients or family members paranoid adverse events had a higher probability of disputes(P=0.016).Conclusion Medical institutions should pay attention to the prevention and control of serious adverse events,and reduce or avoid the occurrence of medical disputes from the aspects of improving the level of medical technology,strengthening the quality and safety management of clinical surgery departments,creating a good patient safety culture atmosphere,and paying attention to the change of psychological and social environment of patients.