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医疗纠纷调解处置对策与方法

医疗纠纷是医院运行发展中一个难以回避的问题，军队医院也不例外。为防范疗纠纷，应从加强管理组织体系、强化医务人员法制观念、健全医疗规章制度、强化环节质量管理控制、实施责任追究制等方面采取一系列对策与措施，使医疗差错和医疗纠纷得以控制和降低；纠纷事件也可得到科学妥善处置，有力的促进了医院的建设发展和核心保障能力的提升。

Administration of Medical Adverse Event on Super Sized Hospital

摘要:医院有效事前监测、管控医疗不良事件，是保障患者安全、提高医疗质量的管理措施之一。超大型医院对医疗不良事件管理的实战中，建立、实施医疗安全隐患事件关键监测指标、医疗安全隐患事件筛查程序指标，积极开展医疗不良事件后台监管工作，切断医疗安全隐患事件向医疗风险事件演变、医疗风险事件向医疗纠纷事件演变的环节，保障患者安全。Abstract: Effective supervision in advance to the medical adverse event, is one of measures which hospital adopt to guarantee patient safety and enhance medical quality. The actual combat of supervision to the medical adverse event in super sized hospital, set up and put in practice on the key target of supervising the medical adverse event and the key target of ridding procedure, remain in the background and work actively on supervision on the medical adverse event, shut off the road from the medical safety issue to the medical risk issue and the road from the medical risk issue to the medical dissension in order to guarantee the patient safety.

Exploration and practice of constructing medical risk management system based on SPO model

ObjectiveTo provide a reference for the implementation of risk management in other medical institutions by introducing the practical experience of building a medical risk management system in West China Hospital of Sichuan University.MethodsBased on Donabedian’s SPO model, the practical experience in the construction of West China Hospital of Sichuan University was summarized from the aspects of structure, process, and results.ResultsThe establishment of medical risk management system made the hospital adverse event management effect good, and the risk management indicators were good. The average number of medical disputes in hospitals from 2016 to 2018 was 103.33, the average number of medical disputes per 100 medical practitioners was 7.01, the average number of medical disputes per 10 000 surgical cases was 6.55, and the average number of medical disputes per 10 000 cases was 0.18.ConclusionThe construction of medical risk management system is conducive to enhancing the awareness of medical risk prevention among medical institutions, continuously improving the quality of medical care and medical safety of hospitals, ensuring patient safety, promoting harmony between doctors and patients, and promoting the realization of healthy China.

医疗风险防范的认识及应对措施

摘要: 医疗安全是医院正常运行的保证,加强医院安全防范的认识和医疗风险的应对措施非常重要。通过建立医疗安全目标责任制,开展医疗安全教育,加强医疗缺陷监控,严格实行技术准入和人员准入,加强对高风险科室及急诊急救工作的管理,加强医疗感染的管理,加强运行病历环节质量管理,重视社会沟通,加强医院医疗服务信息化建设等,可以不断提高医疗安全意识和防范水平,提高医疗风险应对能力,促进医疗事业和谐发展。

日间手术模式接受意愿及满意度调查分析

目的 调查日间手术患者对日间手术模式的接受意愿及其原因分析。 方法 采用问卷调查法，对2015年6月－8月日间手术的患者实施调查。由调查者于床旁亲自发放问卷，问卷当场回收。 结果 调查共发放问卷110份，回收有效问卷110份，有效率为100%。10例（9.1%）表示非常了解日间手术模式，34例（30.1%）表示了解日间手术模式，12例（10.7%）表示对日间手术模式了解一般，14例（12.5%）表示对日间手术模式不了解，40例（36.6%）表示对日间手术模式非常不了解。91例（82.7%）表示通过医生介绍知道日间手术模式的特点，28例（25.5%）通过亲朋好友的介绍了解一些日间手术模式的特点。98例（89.1%）表示通过住院知晓了日间手术模式的特点和相关信息，12例（10.9%）表示未获得日间手术模式的特点和相关信息。104例（94.5%）表示愿意接受日间手术模式。大部分患者愿意接受日间手术模式的原因是缩短了住院等候时间和治疗时间；不愿意接受日间手术模式的患者主要是担心出院后无医务人员的治疗和护理，影响术后的恢复。患者对就医过程、治疗效果、医护人员服务态度、出院指导均有较高的满意度，分别为96.4%、95.5%、99.1%和90.9%。 结论 日间手术模式是一种安全、快捷的手术模式，患者虽了解程度较低，但亲自体验后仍给予了高度认可。

大型医院医疗安全预防两级监管体系浅析

【摘要】　建立从上而下和从下而上两级医疗安全预防管理模式，是大型医院预防医疗不良事件的重要措施与保证。通过对医疗安全预防管理机制和运行效果的探讨及总结，阐明了两级监管体系在发现、化解、降低各种医疗纠纷隐患及医疗风险中的有效性和作用，可供其他医疗机构参考借鉴。

日间手术的管理

Analysis of the Causes of Delay Discharge Patients after Day Surgery in West China Hospital of Sichuan University

ObjectiveTo analysis the reasons of delayed discharge in day surgery ward, so as to provide the basis for discharged quality monitoring of ambulatory surgery management. MethodsA retrospective survey was conducted on patients admitted in Department of Day Surgery Center of West China Hospital of Sichuan University from April 2012 to August 2014 after day surgery. The characteristics of patients classified as "delayed discharge patients" were described and the factors associated with delayed discharges were analyzed by using SPSS 19.0 software. ResultsA total of 14 560 patients were included, of which 81 patients were classified as "delayed discharge", and the rate of delayed discharge was 0.56% (81/14 560). Single disease delayed discharge rates were as follows: gallstone 2.13% (37/1 737), operation for varicose veins of lower limbs 1.91% (11/576), gastrointestinal polyps resection 0.33% (11/3 325), inguinal herniorrhaphy 0.63% (9/1 424), polyp of vocal cord resection 0.21% (4/1 879), breast package block minimally invasive resection 0.11% (2/1 761), choledochoscopy 0.06% (1/1 563) and other surgical 0.26% (6/2 295). No significant differences were found between the delayed discharge patients and normal discharge patients in age and gender (P>0.05). Compared with the normal discharge patients, there were significant differences in the four aspects of operation mode changes, postoperative complications, anesthesia factors and patient's own factors of delayed discharge patients (P<0.05). ConclusionThe changes of operation mode, postoperative complications, anesthesia factors and patient's own factors are related to the delay of hospital discharge. Strictly grasping the indications for ambulatory surgery and anesthesia patients, strengthening the admission education, letting the patients accept day surgery fully in psychological and preventing the possible complications and ensure the quality and safety after day surgery.

Lean management strategy of day surgery ward

Objective To explore the effect of lean management on patients’ safety, medical quality, and satisfaction in day surgery ward. Methods The patients underwent day surgery between May 4th, 2017 and April 30th, 2018 were selected as the subjects (the lean management of day surgery ward implemented on November 1st, 2017). The patients underwent day surgery between May 4th and October 31st, 2017 were taken as the control group (n=2 864), and the ones between November 1st, 2017 to April 30th, 2018 were taken as the observation group (n=2 705). The following data between the two groups were compared: the cancellation rate of day surgery, the 24-hour delayed discharge rate, the rate of 12-hour median or severe pain after surgery, the rate of 12-hour postoperative nausea and vomiting, the awareness rate of health education, the patients’ satisfaction, and the incidence of adverse events.Results Compared with those in the control group, the cancellation rate of surgery (4.81% vs. 6.25%), the 24-hour delayed discharge rate (2.76% vs. 4.28%), the 12-hour median or severe pain after surgery (5.55% vs. 8.31%), the rate of 12-hour postoperative nausea and vomiting (5.86% vs. 7.71%) decreased in the observation group, and the differences were statistically significant (P<0.05). The awareness rate of health education increased from 92.18% to 98.02% after the implementation of lean management, the patients’ satisfaction increased from 92.48±2.58 to 96.53±1.64 after the implementation of lean management, and the differences were statistically significant (P<0.05). The incidences of adverse events in the two groups were not statistically different (0.16% vs. 0.41%, P>0.05). Conclusion The implementation of lean management model can insure the medical safety and quality of day surgery, and improve overall work efficiency and the patients’ medical service experience in day surgery ward.

Application of Risk Management in Hospital Infection Control and Analysis of Its Effect

目的　探讨风险管理在医院感染管理中的应用与效果。 方法　以风险管理知识为指导，通过分析医院感染管理工作中存在或潜在的医院感染风险制订风险管理预防，指导临床规避和化解感染风险，确保医疗安全。 结果　风险管理的实施提高了医院感染管理质量，减少了医院感染的发生。 结论　风险管理在医院感染管理中的应用不仅可以降低医院感染的风险，也提高了医疗质量。Objective　To investigate the application of risk management in hospital infection control and its effect. 　Methods　Guided by risk-management knowledge, we analyzed the potential infection risks in hospital infection control work and regulated risk management policies, in order to avoid and defuse the risk of infection and ensure medical safety. 　Result　The implementation of risk management improved the quality of hospital infection control, and reduced the incidence of hospital infections. Conclusion　Risk management in hospital infection control can not only reduce the risk of infection, but also improve the quality of care.