儿童急诊安全医疗运行模式的探讨  

Study on the medical safety management mode of pediatric emergency department

作　　者：何时军[1] 黄爱蓉[1] 王传夏[1] 金益梅[1] 周爱华[1] 王霞[1] 

机构地区：[1]温州医学院附属育英儿童医院急诊科,325027

出　　处：《中国小儿急救医学》2008年第4期329-332,共4页Chinese Pediatric Emergency Medicine

摘　　要：目的探讨新型儿童急诊安全医疗运行模式以减少急诊医疗纠纷。方法详细分析本院儿童急诊医疗纠纷和死亡病例的医疗缺陷，据此制定儿童急诊安全医疗运行模式的具体程序，并于2005年10月起，我科全面加以执行该模式。对2005年1月至2007年3月期间病例进行回顾性分析。结果最易引起医疗纠纷的疾病包括儿童暴发性心肌炎、暴发性流行性脑脊髓膜炎、脓毒症。2005年10月至2007年3月期间，执行早期筛选的临床措施后，早期发现了暴发性心肌炎7例，流行性脑脊髓膜炎7例，化脓性脑膜炎6例，发现并汇报潜在医疗纠纷12例，由此阻止潜在严重医疗纠纷3例。在执行安全医疗模式前9个月共21万急诊患儿中，发生严重医疗纠纷和医疗赔偿分别为8例和3例；执行安全医疗模式后17个月共33万急诊患儿中，发生严重医疗纠纷仅1例，无医疗赔偿。结论早期筛选高危患儿的临床措施能提高儿科医师对危重疾病的识别能力，执行儿童急诊安全医疗模式能显著减少严重医疗纠纷。Objective To explore how to establish the emergency model of medical safety in children to reduce medical disputes. Methods We retrospectively analyzed the medical records for hospital deaths and medical disputes. And then we formulated the specific procedures of pediatric emergency safety, which included a clinical pathway of early screening model for high-risk patients, establishment of network for reporting potential medical disputes, creating platform to share clinical experience. The pediatric cases from October 2005 to March 2007 were analyzed and a retrospective analysis was conducted to compare the difference before and after medical safety model establishment. Results Fulminant myocarditis and severe infections often caused medical disputes. From October 2005 to March 2007, seven cases of fulminant myocarditis, seven cases of epidemic cerebrospinal meningitis, and six cases of purulent meningitis were detected in the earlystage. And twelve cases of potential medical disputes were reported in time and three potential severe medical dispute cases were prevented, During the period of nine months before the implementation of medical safety model, 210 000 patients were recruited and 8 cases of medical disputes and 3 cases for medical compehsation occ urred.After the implementation of medical safety model, remarkable improvement had been achieved： during a seventeenmonth period, 1 medical dispute and no medical compensation occurred in a total of 330 000 patients. Conclusion Application of clinical pathway of early screening high-risk patients can improve the early identification of high-risk illness. The implementation of medical safety model can significantly reduce medical disputes.

关 键 词：急诊 医疗纠纷 暴发性心肌炎 筛选 

分 类 号：R473.72[医药卫生—护理学]