Retrospective analysis of medical malpractice claims in tertiary hospitals of China: the view from patient safety.
Retrospective analysis of medical malpractice claims in tertiary hospitals of China: the view from patient safety.
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我国三级医院医疗事故索赔回顾分析：患者安全视角
DOI：
10.1136/bmjopen-2019-034681
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发表时间：
2020-09-24
期刊：
影响因子：
2.9
通讯作者：
Li G
中科院分区：
文献类型：
--
作者：
Li H;Dong S;Liao Z;Yao Y;Yuan S;Cui Y;Li G
目的分析医疗事故索赔，以评估医院患者的安全性。从医疗事故索赔中获得的信息反映了潜在的风险，可能有助于减少医疗差错和提高患者安全。设计、背景：对中国市351家三级甲等医院2008-2017年的4380件医疗事故索赔情况进行分析。我们考察了医疗差错和患者安全的特点，包括医疗差错的类型、比例责任和不同临床专科的医疗事故赔偿。主要结果指标我们评估了索赔特征、支付金额和责任。结果我们的数据分析显示，72.5%的索赔涉及医疗差错，平均支付金额为31 430美元。医院的医疗事故导致了41.4%的患者伤害赔偿金的平均责任。医疗事故多发生在上海(817件，占18.7%)和北京(468件，占10.7%)。医疗差错和医疗事故索赔风险最高的是骨科(占全部索赔的11.3%，医疗差错占72.8%)和妇产科(占所有索赔的10.0%，医疗差错占76.0%)。与比例负债相关的比率最高的是耳鼻咽喉科(51.9%)和内分泌科(47.7%)。呼吸医学在死亡率中所占比例最高(77.3%)。医疗技术差错占91.8%，医德差错占5.8%。平均薪酬最高的是心血管外科(41 733美元)，最低的是口腔外科(8,822美元)。结论前期研究发现，中国三级甲等医院的医疗差错率与全国普通医院相似。36不同的专业在医疗差错、支付和比例责任方面具有不同的风险特征。骨科的不当行为索赔数量最多，承担的比例较高，但死亡率较低。
Objectives The study analysed medical malpractice claims to assess patient safety in hospitals. The information derived from malpractice claims reflects potential risks and could help lead to reducing medical errors and improving patient safety. Design, setting We analysed 4380 medical malpractice claims from 351 grade-A tertiary hospitals in China for 2008–2017. We examined the characteristics of medical errors and patient safety, including the types of medical errors, proportionate liabilities and payments for medical malpractice in different clinical specialties. Main outcome measures We assessed claim characteristics, payment amounts and liability. Results Our data analysis demonstrated that 72.5% of the claims involved medical errors, with average payments of US$31 430. The hospital’s errors in medical malpractice resulted in 41.4% average liability in patient injury payments. Most medical malpractice cases occurred in Shanghai (817 claims, 18.7%) and Beijing (468 claims, 10.7%). The highest risks for medical error and malpractice claims were related to orthopaedics (11.3% of all claims, 72.8% with medical errors) and obstetrics and gynaecology (10.0% of all claims, 76.0% with medical errors). The highest rates related to proportionate liabilities were observed in otolaryngology (51.9%) and endocrinology (47.7%). Respiratory medicine had the highest proportion of claims in death rates (77.3%). Medical technology errors accounted for 91.8% of the claims and medical ethics errors for 5.8%. The highest average payment was found in cardiovascular surgery (US$41 733) and the lowest in stomatology (US$8822). Conclusions A previous study found that grade-A tertiary hospitals in China have similar medical error rates to general Chinese hospitals. 36Different specialties had different risk characteristics regarding medical errors, payments and proportionate liabilities. Orthopaedics had the highest number of malpractices claims and higher proportionate liability but lower death rates.
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