本文關(guān)鍵詞： 神經(jīng)外科 醫(yī)療糾紛 預(yù)警指標(biāo) 預(yù)警預(yù)控　出處：《第二軍醫(yī)大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的收集某軍隊(duì)三甲醫(yī)院神經(jīng)外科2005年-2015年發(fā)生的醫(yī)療糾紛案例,通過對(duì)比發(fā)生醫(yī)療糾紛患者和未發(fā)生醫(yī)療糾紛患者的相關(guān)信息,探索神經(jīng)外科醫(yī)療糾紛預(yù)警指標(biāo),建立神經(jīng)外科醫(yī)療糾紛預(yù)警預(yù)控體系,并通過臨床實(shí)證研究驗(yàn)證其有效性。方法通過文獻(xiàn)檢索和專家咨詢,篩選神經(jīng)外科醫(yī)療糾紛影響因素。通過數(shù)字化病案庫(kù)收集2005年-2015年神經(jīng)外科發(fā)生醫(yī)療糾紛病歷,并隨機(jī)抽取同時(shí)期住院、第一診斷相同、病情嚴(yán)重程度大致相似的普通病歷一份,統(tǒng)計(jì)醫(yī)療糾紛影響因素相關(guān)指標(biāo)。使用SPSS23.0軟件對(duì)收集數(shù)據(jù)進(jìn)行單因素和多因素分析,探索神經(jīng)外科醫(yī)療糾紛預(yù)警指標(biāo),將結(jié)果制成軟件與醫(yī)院信息系統(tǒng)相結(jié)合,建立神經(jīng)外科醫(yī)療糾紛預(yù)警預(yù)控體系,實(shí)際應(yīng)用于臨床,觀察其應(yīng)用效果。結(jié)果2005年-2015年神經(jīng)外科共發(fā)生醫(yī)療糾紛65例,發(fā)生數(shù)量呈逐年上升趨勢(shì),其中91.3%協(xié)商處理,8.7%法院民事調(diào)解。經(jīng)過文獻(xiàn)檢索及專家咨詢篩選患者因素中的患者性別、年齡、婚姻狀況、教育程度、醫(yī)保類別;疾病因素中的入院診斷、格拉斯哥昏迷評(píng)分(Glasgow Coma Scale,GCS評(píng)分)、手術(shù)類別、手術(shù)分級(jí)、麻醉等級(jí)、手術(shù)次數(shù)、術(shù)中出血量、并發(fā)癥發(fā)生、感染、非計(jì)劃再次手術(shù)發(fā)生、病情危重、住院天數(shù)、輸血制品總量、住院費(fèi)用;醫(yī)療結(jié)果中的不良結(jié)局20個(gè)指標(biāo)為神經(jīng)外科醫(yī)療糾紛影響因素。對(duì)影響因素進(jìn)行單因素分析,顯示糾紛組患者與非糾紛組患者在入院診斷、GCS評(píng)分、麻醉等級(jí)、手術(shù)次數(shù)、并發(fā)癥發(fā)生、顱內(nèi)感染發(fā)生、非計(jì)劃二次手術(shù)、病情危重、住院天數(shù)、輸血總量、醫(yī)療費(fèi)用、不良結(jié)局12項(xiàng)指標(biāo)比較中有統(tǒng)計(jì)學(xué)意義(P0.05);對(duì)這12項(xiàng)指標(biāo)進(jìn)行l(wèi)ogistic回歸分析顯示,GCS評(píng)分、并發(fā)癥發(fā)生、感染發(fā)生、非計(jì)劃二次手術(shù)、住院天數(shù)、醫(yī)療費(fèi)用、不良結(jié)局7項(xiàng)指標(biāo)是神經(jīng)外科醫(yī)療糾紛發(fā)生的危險(xiǎn)因素。根據(jù)分析結(jié)果,將以上7個(gè)指標(biāo)作為神經(jīng)外科醫(yī)療糾紛預(yù)警干預(yù)指標(biāo),將預(yù)警指標(biāo)及其閾值與醫(yī)院信息系統(tǒng)結(jié)合,建立神經(jīng)外科醫(yī)療糾紛預(yù)警預(yù)控系統(tǒng)并應(yīng)用于臨床。經(jīng)過1年的實(shí)證研究,2016年神經(jīng)外科共發(fā)生醫(yī)療糾紛2例,發(fā)生率為0.12%,較過去有明顯下降(P0.05)。結(jié)論神經(jīng)外科患者大多病情復(fù)雜、危重、變化迅速,臨床工作專業(yè)性強(qiáng)、風(fēng)險(xiǎn)頻發(fā),且患者術(shù)后并發(fā)癥及后遺癥多,死亡率相對(duì)較高,容易導(dǎo)致患者及家屬不理解,導(dǎo)致醫(yī)療糾紛,給醫(yī)務(wù)人員工作帶來巨大隱患。本研究所選指標(biāo)均為神經(jīng)外科患者臨床指標(biāo),具有易提取、可量化、敏感度高的特點(diǎn),為建立神經(jīng)外科醫(yī)療糾紛預(yù)警信息系統(tǒng)提供了科學(xué)、可靠依據(jù)。將預(yù)警指標(biāo)與醫(yī)院信息系統(tǒng)結(jié)合,對(duì)住院患者實(shí)施住院全過程、實(shí)時(shí)的動(dòng)態(tài)監(jiān)控,及時(shí)預(yù)警,根據(jù)預(yù)警指標(biāo)有針對(duì)性進(jìn)行有效防控,全面實(shí)施醫(yī)療糾紛預(yù)警預(yù)控管理,使神經(jīng)外科醫(yī)療糾紛投訴明顯減少,顯著降低科室醫(yī)療風(fēng)險(xiǎn)。
[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.
【學(xué)位授予單位】：第二軍醫(yī)大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R82

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