某军队三甲医院神经外科医疗纠纷预警预控研究

发布时间：2018-02-11 08:40

本文关键词： 神经外科医疗纠纷预警指标预警预控　出处：《第二军医大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的收集某军队三甲医院神经外科2005年-2015年发生的医疗纠纷案例,通过对比发生医疗纠纷患者和未发生医疗纠纷患者的相关信息,探索神经外科医疗纠纷预警指标,建立神经外科医疗纠纷预警预控体系,并通过临床实证研究验证其有效性。方法通过文献检索和专家咨询,筛选神经外科医疗纠纷影响因素。通过数字化病案库收集2005年-2015年神经外科发生医疗纠纷病历,并随机抽取同时期住院、第一诊断相同、病情严重程度大致相似的普通病历一份,统计医疗纠纷影响因素相关指标。使用SPSS23.0软件对收集数据进行单因素和多因素分析,探索神经外科医疗纠纷预警指标,将结果制成软件与医院信息系统相结合,建立神经外科医疗纠纷预警预控体系,实际应用于临床,观察其应用效果。结果2005年-2015年神经外科共发生医疗纠纷65例,发生数量呈逐年上升趋势,其中91.3%协商处理,8.7%法院民事调解。经过文献检索及专家咨询筛选患者因素中的患者性别、年龄、婚姻状况、教育程度、医保类别;疾病因素中的入院诊断、格拉斯哥昏迷评分(Glasgow Coma Scale,GCS评分)、手术类别、手术分级、麻醉等级、手术次数、术中出血量、并发症发生、感染、非计划再次手术发生、病情危重、住院天数、输血制品总量、住院费用;医疗结果中的不良结局20个指标为神经外科医疗纠纷影响因素。对影响因素进行单因素分析,显示纠纷组患者与非纠纷组患者在入院诊断、GCS评分、麻醉等级、手术次数、并发症发生、颅内感染发生、非计划二次手术、病情危重、住院天数、输血总量、医疗费用、不良结局12项指标比较中有统计学意义(P0.05);对这12项指标进行logistic回归分析显示,GCS评分、并发症发生、感染发生、非计划二次手术、住院天数、医疗费用、不良结局7项指标是神经外科医疗纠纷发生的危险因素。根据分析结果,将以上7个指标作为神经外科医疗纠纷预警干预指标,将预警指标及其阈值与医院信息系统结合,建立神经外科医疗纠纷预警预控系统并应用于临床。经过1年的实证研究,2016年神经外科共发生医疗纠纷2例,发生率为0.12%,较过去有明显下降(P0.05)。结论神经外科患者大多病情复杂、危重、变化迅速,临床工作专业性强、风险频发,且患者术后并发症及后遗症多,死亡率相对较高,容易导致患者及家属不理解,导致医疗纠纷,给医务人员工作带来巨大隐患。本研究所选指标均为神经外科患者临床指标,具有易提取、可量化、敏感度高的特点,为建立神经外科医疗纠纷预警信息系统提供了科学、可靠依据。将预警指标与医院信息系统结合,对住院患者实施住院全过程、实时的动态监控,及时预警,根据预警指标有针对性进行有效防控,全面实施医疗纠纷预警预控管理,使神经外科医疗纠纷投诉明显减少,显著降低科室医疗风险。
[Abstract]:Objective to collect the cases of medical disputes between 2005 and 2015 in neurosurgery of a third Class A military hospital, and to explore the early warning index of medical disputes in neurosurgery by comparing the relevant information between patients with medical disputes and those without medical disputes. To establish an early warning and control system for medical disputes in neurosurgery, and to verify its effectiveness through clinical empirical research. Screening the influencing factors of medical disputes in neurosurgery, collecting medical records of medical disputes in neurosurgery from 2005 to 2015 by digital medical record bank, and randomly sampling the medical records of medical disputes in the same period, the first diagnosis was the same. A common medical record with similar severity, statistics related indexes of influencing factors of medical disputes, using SPSS23.0 software to carry out single factor and multi-factor analysis to collect data, to explore the early warning index of medical disputes in neurosurgery. The results were made into software and hospital information system to establish the early warning and control system of medical disputes in neurosurgery, which was applied in clinical practice and observed its effect. Results 65 cases of medical disputes occurred in neurosurgery from 2005 to 2015. The number of cases increased year by year, of which 91.3% negotiated and dealt with 8.7% of civil mediation in court. The gender, age, marital status, educational level, medical insurance type of patients were selected by literature retrieval and expert consultation. Admission diagnosis, Glasgow Coma scale score, surgical classification, surgical grading, anesthetic grade, number of operations, intraoperative bleeding, complications, infection, unscheduled reoperation, critical condition, The number of days in hospital, the total amount of blood transfusion products, the cost of hospitalization, the 20 indexes of bad outcome in medical results were the influencing factors of medical disputes in neurosurgery. The GCS score, anesthesia grade, number of operations, complications, intracranial infection, unscheduled secondary operation, critical condition, hospitalization days, total blood transfusion, medical expenses were observed in patients with dispute group and non-dispute group. The logistic regression analysis showed that the logistic scores, complications, infection, unscheduled secondary surgery, hospitalization days, medical expenses, etc. According to the analysis results, the above 7 indexes were taken as the early warning intervention indexes of neurosurgery medical disputes, and the early warning indexes and their thresholds were combined with the hospital information system. In 2016, 2 cases of medical disputes occurred in neurosurgery, the incidence rate was 0.12, which was significantly lower than that in the past (P 0.05). Conclusion the patients with neurosurgery are mostly complicated. Serious, rapid changes, strong professional clinical work, frequent risk, and more postoperative complications and sequelae, the mortality rate is relatively high, easy to lead to patients and their families do not understand, leading to medical disputes, The indexes selected in this study are all clinical indexes of neurosurgery patients, which are easy to extract, quantifiable and sensitive, which provide a scientific method for the establishment of early warning information system for medical disputes in neurosurgery. Reliable basis. Combining the early warning index with the hospital information system, implementing the whole hospitalization process, real-time dynamic monitoring, timely early warning, effective prevention and control according to the early warning index, The comprehensive implementation of early warning and pre-control management of medical disputes can reduce the complaints of medical disputes in neurosurgery and reduce the risk of medical treatment in departments.
【学位授予单位】：第二军医大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R82

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