北京市地方标准视域下一级医院医疗过错根原因分析及改进措施建议OA

Background In the mediation and handling of doctor-patient disputes in primary hospitals,in most cases,it is recognized that the medical party has made mistakes in the diagnosis and treatment behavior.It is an important responsibility for medical institutions and health administrative authorities to promptly detect and reduce or eliminate the occurrence of medical errors.Promoting the improvement and enhancement of medical quality in primary hospitals is of special significance.The promulgation of the local standard"Code Specification for Key Control Points of Medical Behavior"in Beijing has made it possible to analyze the root causes of standardization of medical errors in primary hospitals.Objective To explore the root causes of medical errors in primary hospitals under the perspective of local standards in Beijing and measures for improving medical quality.Methods We collected judgments from various levels of people's courts in Beijing from 2019 to 2022 regarding medical damage as a cause of action,involving medical errors in first level hospitals in Beijing,as the research object.We applied the Beijing local standard"Code Specification for Key Control Points of Medical Behavior"as the basis to summarize and analyze the root causes of medical errors,and provided improvement measures for improving medical quality.Results From 2019 to 2022,there were a total of 127 judgments/rulings involving first level hospitals in Beijing that identified faults in the hospital's diagnosis and treatment behavior,based on medical damage as the cause of action.Among the root causes,the top one was poor communication between doctors and patients(32 cases,25.2%),followed by unstable treatment plans(31 cases,24.4%),lack of medical record writing(23 cases,18.1%),and exceeding the scope of practice(17 cases,13.4%).The proportion of over-range practice fault in different hospital categories was statistically significant(P<0.05).The pairwise comparison within groups showed that the proportion of over-range practice fault in tertiary hospitals was higher than that in primary hospitals and secondary hospitals,and the difference was statistically significant(P<0.016).Conclusion The main root causes of medical errors in first level hospitals under the perspective of local standards in Beijing are poor communication quality between doctors and patients,unstable formulation of treatment plans,non-standard medical record writing,and exceeding the scope of practice.Targeted correction can improve the medical quality of first level hospitals and safeguard the legitimate rights and interests of both doctors and patients.