安全文化视角下住院患者自杀风险评估指标体系及危机管理模型构建

自杀是一个非常严重的公共卫生问题。医院管理以患者为中心，以质量安全为核心，预防住院患者自杀等不良事件发生，保障患者安全，是医院的重要职责与任务。综合医院住院患者的自杀问题尚未引起足够重视，本课题前期研究发现，住院患者自杀与个体原因、家庭支持系统、医护人员认知及医院组织管理等都存在一定关系。本课题从安全文化视角下，拟运用定性与定量相结合的研究方法，采用问题-成因-对策公共政策逻辑分析方法，深入探析住院患者自杀现状与影响因素，运用ROC曲线、结构方程模型等统计方法找出其自杀主要影响因素；通过专家咨询、层次分析法等主客观相结合方法，建立住院患者自杀风险评估指标体系并校验；基于自杀“过程观”、危机管理三阶段模型理论，构建包括患方、医方、医院组织管理三方的我国综合医院住院患者自杀危机管理模型，最大限度地防范和减少住院患者自杀，为政府制定相关政策提供重要理论支撑与决策依据。

Suicide is a very serious public health problem. Patient is the center, and quality and safety are the core of hospital management, prevention of patient suicide and other adverse events to ensure patients’ safety are the important responsibility and task of hospital. While suicide problems of inpatients in general hospital have not been paid enough attention. Our previous studies have found that, inpatient suicide had something to do with the causes of individualized patients, family support system, cognition of medical staff, organization management of hospital and so on. Under the perspective of safety culture, this study will use qualitative and quantitative research methods, and the public policy logic analysis method of problem-causes-strategy, to deeply explore and analyze status and influencing factors of inpatient suicide, and utilize ROC curve, structural equation model and so on statistical methods to find the main influencing factors of suicide. Expert consultation, analytic hierarchy process and other subjective and objective methods will be used to establish suicide risk assessment index system and check. Based on the process view of suicide, three stages model theory of crisis management, then the suicide crisis management model which including inpatients and relatives, medical staffs and organization management of hospital will be established for inpatients in Chinese general hospital, to prevent and reduce inpatient suicide to the largest extent, and to provide important theoretical support and policy-making evidence for government.