摘要
目的探寻兰州市省属医院医疗纠纷发生情况及其原因,为进一步精准制定医疗纠纷的预防和处置措施奠定基础。方法回顾性分析甘肃第三方医疗纠纷人民调解委员会2015-2020年处理的兰州市13家省卫健委直属医院归档结案的629例医疗纠纷案件的基本人口学信息、纠纷原因等,依据《医疗过失分类编码》中一、二、三级指标对医疗纠纷发生的原因进行分析。组间比较使用χ^(2)检验或Fisher确切概率法。结果住院(81.72%)、女性(54.69%)、年龄40~60岁(32.59%)和农民患者(32.75%)医疗纠纷发生最多。医疗纠纷发生原因一级指标以医疗技术过失(69.48%)、医疗人文过失(24.64%)和医疗流程过失(3.49%)为主;二级指标以手术/操作相关(27.19%)、治疗相关(22.26%)和医患沟通相关(19.71%)为主;三级指标以沟通措辞不当导致误解(19.39%)最常见。门急诊和住院患者的医疗纠纷发生原因不尽相同,差异有统计学意义(χ^(2)=27.166,P<0.05);不同性别患者(χ^(2)=10.212,P=0.116)和不同年龄段患者(χ^(2)=17.799,P=0.469)的医疗纠纷发生原因无差别,差异均无统计学意义;不同职业患者的医疗纠纷发生原因不尽相同,差异有统计学意义(χ^(2)=42.314,P=0.012)。结论医院应提高医疗技术水平、重视医疗人文建设、优化医疗流程,并根据不同诊疗场所、不同特征患者建立有效机制来减少医疗纠纷的发生。
Objective To explore the situation and causes of medical disputes in provincial hospitals of Lanzhou,and to lay a foundation for formulating the prevention and treatment measures of medical disputes.Methods The method of retrospective analysis was applied for the basic demographic information and causes of 629 cases of medical disputes,which were handled by the People’s Mediation Committee for third-party medical disputes of Gansu Province and 13 hospitals affiliated to the Provincial Health Commission in Lanzhou between 2015 and 2020 were recruited,then the causes of medical disputes were analyzed according to the first,second and third level indexes in medical negligence classification code.χ^(2)test or Fisher was adopted to compare between groups.Results 81.72%of in-patients,54.69%of female patients,32.59%of 40~60-year-old patients and 32.75%of peasant patients respectively had the most medical disputes.The first-level indicators of the causes of medical disputes were mainly medical technical fault(69.48%),medical humanistic fault(24.64%)and medical process fault(3.49%);the second-level indexes were related to operation(27.19%),treatment(22.26%)and doctor-patient communication(19.71%);the third-level indexes were related to miscommunication(19.39%).The causes of medical disputes were different between patients in out-patient and in-patient department(χ^(2)=27.166,P<0.05),and there was no significant difference in the causes of medical disputes between patients of different gender(χ^(2)=10.212,P=0.116)and different age(χ^(2)=17.799,P=0.469),while there was significant difference in the causes of medical disputes between patients of different occupation(χ^(2)=42.314,P=0.012).Conclusions Hospitals should improve the level of medical technology,pay attention to the construction of medical humanities,optimize the medical process,and establish effective mechanisms to reduce the occurrence of medical disputes according to different diagnosis and treatment places and patients with different characteristics.
作者
王斌
杨一龙
雷泽林
王立先
崔琦
张入文
彭伟军
王永军
张晓光
WANG Bin;YANG Yilong;LEI Zelin;WANG Lixian;CUI Qi;ZHANG Ruwen;PENG Weijun;WANG Yongjun;ZHANG Xiaoguang(Department of Medical Administration,the First Hospital of Lanzhou University,Lanzhou 730000,China 2.The First School of Clinical Medicine of Lanzhou University,Lanzhou 730000,China 3.The Third Party of Medical Mediation Committee Office of Gansu,Lanzhou 730000,China)
出处
《安徽医学》
2023年第2期212-217,共6页
Anhui Medical Journal
基金
甘肃省卫生健康行业科研计划项目(编号:GSWSKY2020-45),兰州大学大学生创新创业行动计划项目(编号:20200060017)。
关键词
医疗纠纷
医患关系
原因分析
Medical disputes
Doctor-patient relationship
Causes analysis
