医疗纠纷发生原因分析及对策研究——基于某医院2018-2023年医疗纠纷处理的实践  

Analysis of the causes of medical disputes and research on countermeasures:based on the practice of handling medical disputes in a certain hospital from 2018 to 2023

作　　者：闫晓婷[1] 樊毅[2] 佘苗 YAN Xiaoting;FAN Yi;SHE Miao(Department of Medical Affairs,the First Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710061,China;Department of Neurosurgery,the First Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710061,China;Medical Ethics Office,Department of Science and Technology,the First Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710061,China)

机构地区：[1]西安交通大学第一附属医院医务部,陕西西安710061 [2]西安交通大学第一附属医院神经外科,陕西西安710061 [3]西安交通大学第一附属医院科技部医学伦理办公室,陕西西安710061

出　　处：《中国医学伦理学》2025年第1期131-138,共8页Chinese Medical Ethics

基　　金：陕西省创新能力支撑计划“DRGs支付方式改革对公立医院医疗服务行为影响的研究”(2022KRM194);西安交通大学第一附属医院科研发展基金“基于DRGs病组下全诊疗过程知情同意体系的建设”(2022RKX-10)。

摘　　要：目的 探讨2018—2023年西安市某三甲综合医院医疗纠纷的现状和原因及对策。方法 收集2018年1月至2023年12月西安市某三甲医院已处理完结的804例医疗纠纷案例,回顾性分析医疗纠纷发生情况、现状特点和原因分布。结果医疗纠纷累计发生率为4.408/10万,赔付率为31.59%(254/804),2018—2023年医疗纠纷发生率和赔付率整体呈逐年增长的趋势(P<0.05);6年纠纷案例中死亡患者占比呈逐年增加的趋势(χ^(2)=30.396,P=0.011),医疗纠纷案例主要来源于住院患者(65.17%)和接受手术治疗的患者(55.35%),发生医疗纠纷案例排名前五位的科室依次为肝胆外科、心血管内科、妇产科、急诊科和消化内科;2018—2023年院内调解逐年降低,而人民调解呈逐年增加趋势(χ^(2)=34.523,P<0.001);该医院医疗纠纷案例的发生原因前五位为:手术/操作并发症(29.10%)、病情评估/疾病诊断(10.45%)、诊疗方案(9.45%)、诊疗效果(8.83%)以及医保报销(7.59%)。结论 综合医院医疗纠纷和赔付案件逐年增加,对于手术科室、急诊科等高风险科室需高度关注;医疗纠纷处理方式展现为多元化,人民调解逐渐占据主导地位;医疗纠纷发生原因主要集中在诊疗技术、医患沟通、医疗保险等方面,需不断提升临床诊疗技术水平,加强医患沟通,完善医疗保障体系,强化医院内涵管理,缓解医患矛盾,构建和谐医患关系。Objective:To explore the current situation,causes,and countermeasures of medical disputes in a tertiary A comprehensive hospital in Xi’an from 2018 to 2023.Methods:A total of 804 medical dispute cases that had been processed in a tertiary A hospital in Xi’an from January 2018 to December 2023 were collected.The occurrence,current characteristics,and cause distribution of medical disputes were retrospectively analyzed.Results:The cumulative incidence rate of medical disputes was 4.408/100,000,and the compensation rate was 31.59%(254/804).The incidence and compensation rate of medical disputes showed an overall increasing trend year by year from 2018 to 2023(P<0.05).The proportion of deceased patients in dispute cases in the past 6 years showed an increasing trend annually(χ^(2)=30.396,P=0.011).Medical dispute cases mainly came from hospitalized patients(65.17%)and patients undergoing surgical treatment(55.35%),and the top five departments with medical dispute cases were the hepatobiliary surgery department,cardiovascular medicine department,obstetrics and gynecology department,emergency department,and gastroenterology department.The number of in-hospital mediations showed a decreasing trend annually,while the number of people’s mediations showed an increasing trend annually from 2018 to 2023(χ^(2)=34.523,P<0.001).The top five causes of medical disputes in this hospital were surgical/operational complications(29.10%),disease condition assessment/disease diagnosis(10.45%),diagnosis and treatment plan(9.45%),diagnosis and treatment effectiveness(8.83%),and medical insurance reimbursement(7.59%).Conclusion:The number of medical disputes and compensation cases in comprehensive hospitals is increasing annually,and high-risk departments such as the surgical department and emergency department need to be given high attention.The handling of medical disputes has shown diversification,with people’s mediation gradually taking the dominant position.The causes of medical disputes mainly concentrated on diagnosis and

关 键 词：医疗纠纷 医患关系 综合医院 医患沟通 

分 类 号：R-052[医药卫生]