基于医疗安全的医院建筑空间环境风险控制研究

发布时间：2018-03-20 09:15

  本文选题：医院建筑　切入点：医疗安全　出处：《哈尔滨工业大学》2017年博士论文　论文类型：学位论文

【摘要】：对医疗安全进行建筑学角度的理性思考是一种时代的需求。本研究致力于探析影响医疗安全的建筑空间环境要素,为相关风险控制提供理论和实践层面的依据。医疗安全是一个严肃的公共卫生问题,事关生命健康、社会稳定。频发的医院安全事件显示出现阶段我国的医疗安全水平并未满足人们的安全需求。医疗安全风险控制是一项系统工程,建筑空间环境作为承载医疗活动的平台是风险控制的重要组成部分,医院建筑设计的安全不仅是本体安全,更重要的是保障医疗安全这个核心目标,建筑学科必须承担起在系统工程中的角色,从建筑领域出发寻找解决医疗安全问题的新途径,并最终实现促进社会发展和个体自由的目标。本研究从医疗安全的视角出发,以系统论、安全学的相关思想为指导,以医学的经验反馈和实际调研数据为依据,以空间环境对行为心理的影响为连接,完成了医疗安全与空间环境要素在理论研究和实践操作两个层面的对接,完善了医院建筑设计的安全观,为具体的风险控制和设计实践提供依据,以期达到发挥空间环境对医疗活动的积极作用,规避或降低空间环境对医疗活动的负面影响。筛选与空间环境密切相关且重要的医疗安全问题进行深入研究是形成具有可操作性成果的前提,因此本研究立足多个环节的调研挖掘,确立了四方面问题,依次为医疗失误、医源性感染、意外伤害、职业暴露。在此基础上针对每个问题按照“问题属性分析——作用机制解析——风险要素提取——风险等级分析——风险控制模型建构——提出风险控制策略”的思路进行专项研究。本研究首先明晰了空间环境与医疗安全之间的作用机制,二者关系的清晰认识是风险控制的基础。其次,通过医疗安全的数据查阅、医院环境的实况观察、医护专家访谈等多个渠道对上述四大医疗安全问题的具体空间环境影响要素进行遴选,是为风险识别。再次,对空间环境要素的风险等级运用非交锋式专家意见法进行征集,根据影响程度和作用频度两个方向综合确定了空间环境要素的风险等级,并对风险要素的等级分布进行分析,是为风险评估。最后,通过上述研究过程,从建筑学角度建立四个专项医疗安全问题的风险控制模型,并根据风险要素的风险等级及其在建筑学范畴内的可控程度,确立了每类问题的控制要点,并据此提出空间环境视角的控制策略,是为风险控制。(1)针对医疗失误的空间环境控制策略可概括为:提高空间组织的高效精益、控制空间环境的感知混乱度、创造有利于减轻疲劳感的工作环境、提升就诊环境的患者安全感。(2)针对医源性感染的空间环境控制策略可概括为:通过空间环境设计改善微生物环境、减少患者院内转移以及控制人员之间的接触行为。(3)针对意外伤害的空间环境策略可概括为:完善功能布局尽量减少患者不必要的移动、尽可能提供移动过程中的各项支撑需求、创造有利于积极护理的护理环境。(4)针对职业暴露的空间环境策略可概括为:通过空间环境措施削弱暴露源、通过建筑空间布局控制危害范围、通过医疗操作环境的改善控制侵入行为、针对特定侵入途径设置建筑学角度的技术屏障。
[Abstract]:The rational thinking of architecture perspective on medical security is a demand of the era. The elements of building space environment research devoted to the influence of medical safety, relevant risk control provides theoretical and practical basis. Medical security is a serious public health problem is related to life and health, social stability and frequent hospital safety. The medical security level event to display the present stage our country did not meet the security needs of the people. The risk control of medical security is a systematic engineering, architectural space environment as the bearer of the medical activities of the risk control platform is an important part of the architectural design of the hospital safety is not only the body safety, more important is the core goal of medical security security architecture should take the role in system engineering, from the aspect of building areas to find new ways to solve the medical security problems, and And ultimately to promote social development and individual freedom. This study from the perspective of medical safety, based on the system theory, the related thought of security as a guide to medical experience feedback and the actual survey data as the basis, the effect of space environment on the psychological behavior for the connection, complete medical security and environmental factors in the space the docking of theoretical research and practice of two aspects, to improve the security of hospital building design, provide the basis for risk control and design practice, in order to play a positive role in space environment on medical activities, to avoid or reduce the negative effects of space environment on medical activities. Medical security screening and space environment relevant and important in-depth study is formed with the premise of the outcome of the operation, so the research of this study based on the aspects of mining, established four aspects of problems, In order to medical errors, iatrogenic infection, accidental injury, occupation exposure. On the basis of each issue in accordance with the "- mechanism analysis -- risk factors -- Extraction risk level -- Analysis of risk control model construction, put forward the risk control strategy of" the idea of the special analytical properties. This study first clarified the mechanism the space between the environment and medical security, a clear understanding of the relationship between the two is the basis of risk control. Secondly, the medical safety data access, live observation of hospital environment, the selection of medical expert interview a number of channels specific space environment on the four issue of medical safety factors, risk identification is again. The space environment elements, the level of risk by using non confrontation type expert opinion collection, according to the influence and effect of two directions in frequency He determined the spatial elements of the environment risk grade, and the grade distribution of the elements of risk analysis for risk assessment. Finally, through the research process, the risk control model to build four special medical security problem from the angle of architecture, and according to the risk factors of the risk level and its controllable degree in architecture in the context of the establishment the control points of each kind of problem, and put forward the control strategy from the perspective of space environment, is to control risk. (1) according to the medical error space environment control strategy can be summarized as follows: to improve the efficiency of lean space organization, control of the space environment perception disorder, create a favorable working environment to reduce fatigue, improve with a sense of security medical environment. (2) for iatrogenic infection in the space environment control strategy can be summarized as follows: to improve the microbial environment through the design of the space environment, reduce the patients turn The contact behavior between the shift and control personnel. (3) according to the space environment strategy accident can be summarized as follows: perfect the function layout to minimize unnecessary movement of patients, as far as possible to provide the mobile process support demand, create a positive environment conducive to nursing care. (4) according to the space occupation exposure strategy can be summarized as: the space environment measures to minimize the exposure to the source, through the construction of space layout control the harm scope, control of intrusive behavior through medical operating environment improvement, according to the specific technical barriers pathways settings architecture perspective.

【学位授予单位】：哈尔滨工业大学
【学位级别】：博士
【学位授予年份】：2017
【分类号】：TU246.1
，

本文编号：1638436