英美澳加和中國臺灣地區ICU醫療風險管理分析_《中國循證醫學雜志》

作者：

孫紐云 ¹ , 崔小花 ² ,  梁銘會 ¹ , 王莉 ² , 李幼平 ² , 成嵐 ² , 李筱 ² , 袁強 ²

1. 衛生部醫院管理研究所（北京 100083）；2. 四川大學華西醫院中國循證醫學中心（成都 610041）;

關鍵詞：

醫療風險 ICU 風險管理

DOI：

10.7507/1672-2531.20110062

視頻：

導出 下載 收藏 掃碼 引用

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

目的　比較分析美、英、加、澳和中國臺灣地區醫療風險與預警監測系統管理模式，為我國醫療風險管理提供決策依據和政策建議。
方法　檢索上述四國一區醫療風險管理相關機構官方網站（截止至2010年12月），納入規范性文件、學術研究報告、綜述、官網一般信息等，詳細篩選和提取相關資料，并按不同主題進行描述性分析。
結果　① 共納入142篇文獻，美國文獻量最大（68篇），質量較高的規范性文件也最多（8篇）。② 四國一區上報系統隨啟動時間長短，上報事件類型、范圍不斷擴展，從最初用藥差錯/醫院感染事件擴展到近似差錯事件，目前已囊括全部病人安全事件。③ 國家層面的管理模式可歸納為兩個體系，即以英國為代表的國家主導模式和以美、加、澳為代表的法律/法規/行業協會協同模式。兩種模式在法律/法規、標準化、規范化、資金來源等方面均有自身突出優點。④ 為特別需求設立的國家級系統分兩類，即造成死亡或嚴重傷害的事件上報系統（包括美國警訊事件數據庫和英國嚴重事件報告與學習框架）及醫院感染事件監測系統（美國全國醫療安全網）。其針對性較強，有利于特殊事件的監測、處理和預警。⑤ 國家二級政府系統的比較研究選取美國印第安納州政府強制報告內容和程序與中國臺灣病人安全通報系統。后者對事件對象、上報內容定位更廣泛系統，兼顧風險管理各環節，值得借鑒；⑥ 比較四國一區總體上報事件結果表明：目前英國系統最完善，加拿大系統需發展完善的環節最多。
結論　① 英國醫療風險管理系統為國家主導的中央集權管理，是目前最完備的系統；② 美國系統啟動最早，雖管理范圍局限，但依靠其相對最完善的法律/法規保障，仍能有效發揮作用；③ 加、澳兩國借鑒美、英經驗，仍在不斷發展完善中；④ 中國臺灣地區系統比美國印第安納州政府系統各方面內容更充實，可操作性更強，值得借鑒。目的　通過分析四國一區ICU風險管理政策指南、機構管理和運行機制等，為我國ICU風險管理提供決策依據和政策建議。
方法　計算機檢索PubMed,、EMbase, Cochrane Library等數據庫，納入美國、英國、加拿大、澳大利亞和中國臺灣地區ICU風險管理相關指南、研究報告等文獻，綜合分析四國一區風險管理的機構和運行機制，并重點關注英國模式。
結果　共納入31篇文獻，包括1篇指南、5篇綜述、2篇調查報告和23篇研究。英國以標準和指南形式指導ICU風險管理，制定明確的事件分級工具和相應響應機制。美國借鑒澳大利亞經驗建立了ICU安全報告系統，二者均將ICU作為整個醫療風險管理的一部分，設立專門的管理板塊。
結論　英國將ICU風險管理納入國家病人安全管理范圍，單獨設立報告系統，是目前較完備的系統。澳、美由國家機構設立ICU風險管理研究項目，行業協會和非政府組織主導風險研究，由試點單位使用后逐步推廣使用。

引用本文： 孫紐云,崔小花,梁銘會,王莉,李幼平,成嵐,李筱,袁強. 英美澳加和中國臺灣地區ICU醫療風險管理分析. 中國循證醫學雜志, 2011, 11(4): 357-366. doi: 10.7507/1672-2531.20110062 復制

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2.	The Intensive Care Society. Standards for critical incident reporting in critical care (2006). [2011-1-17]Available from: URL: http://www.npsa.nhs.uk/health/resources.
3.	Reader T, Flin R, Lauche K, et al . Non-Technical Skills in the Intensive Care Unit. [2011-1-17] Available from: URL: http://www.sciencedirect.com/.
4.	Health Technology Assessment(HTA). The investigation and analysis of critical incidents and adverse events in healthcare(2005). [2011-1-17]Available from: URL: http://www.sciencedirect.com/.
5.	Spigelman AD, Swan J. Review of the Australian incident monitoring system. ANZ J of Sur , 2005, 75(8): 657-661.
6.	Wu AW, Pronovost P, Morlock L. ICU incident reporting systems. J Crit Care , 2002, 17(2): 86-94.
7.	Holzmueller CG, Pronovost PJ, Dickman F, et al . Creating the Web-based Intensive Care Unit Safety Reporting System. J Am Med Inform Assoc , 2005, 12(2): 130-139.
8.	Allan G. Improving the Intensive Care Unit. [2011-1-17] Available from: URL: http://www.sciencedirect.com/.
9.	McCauley K, Irwin RS. Changing the Work Environment in ICUs to Achieve Patient-Focused Care. Chest , 2006, 130(5): 1571-1578.
10.	Thomas AN, Pilkington CE, Greer R. Critical incident reporting in UK intensive care units: a postal survey. J Eval Clin Pract , 2003, 9(1): 59-68.
11.	Scholefield H. Safety in obstetric critical care. Best Pract Res Clin Obstet Gynaecol , 2008, 22(5): 965-982.
12.	Gunning KE. Critical incident reporting in Intensive Care. Intensive Care Med , 2000, 26(1): 8-10.
13.	Pronovost PJ, Berenholtz SM, Goeschel C, et al . Improving patient safety in intensive care units in Michigan. J Crit Care , 2008, 23(2): 207-221.
14.	Pronovost PJ, Morlock LL, Sexton JB, et al . Improving the Value of Patient Safety Reporting Systems. [2011-1-17] Available from: URL: http://www.sciencedirect.com/.
15.	Lacey S, Smith JB, Cox K. Pediatric Safety and Quality. [2011-1-17] Available from: URL: http://www.sciencedirect.com/.
16.	Suresh G, Horbar JD, Plsek P, et al . Voluntary Anonymous Reporting of Medical Errors for Neonatal Intensive Care. Pediatrics , 2004, 113(6): 1609-1618.
17.	Baldwin I, Beckman U, Shaw L, et al . Australian Incident Monitoring Study in intensive care: local unit review meetings and report management. Anaesth Intensive Care , 1998, 26(3): 294-297.
18.	Beckmann U, Baldwin I, Hart GK, et al . The Australian Incident Monitoring Study in Intensive Care: AIMS-ICU. Ananalysis of the first year of reporting. Anaesth Intensive Care , 1996, 24(3): 320-329.
19.	Beckmann U, West LF, Groombridge GJ, et al . The Australian Incident Monitoring Study in Intensive Care: AIMS-ICU. The development and evaluation of an incident reporting system in intensive care. Anaesth Intensive Care , 1996, 24(3): 314-319.
20.	Beckmann U, Bohringer C, Carless R, et al . Evaluation of two methods for quality improvement in intensive care: Facilitated incident monitoring and retrospective medical chart review. Critical Care Med , 2003, 31(4): 1006-1011.
21.	Pronovost P, Goeschel C. Improving ICU Care: It Takes a Team. Healthc Exec , 2005, 20(2): 14-22.
22.	Schuerer DJ, Nast PA, Harris CB, et al . A New Safety Event Reporting System Improves Physician Reporting in the Surgical Intensive Care Unit. J Am Coll Surg , 2006, 202(6): 881-887.
23.	Donze A, Wolf M. St. Safety in the NICU Preventing Medication Errors with Computerized Provider Order Entry. Nurs Womens Health , 2007, 11(6): 612-617.
24.	Hazlehurst B, McMullen C. Orienting frames and private routines: The role of cultural process in critical care safety. Int J Med Inform , 2007, 76(1): S129-135.
25.	Scanlon MC, Mistry KP, Jeffries HE. Determining pediatric intensive care unit quality indicators for measuring pediatric intensive care unit safety. Pediatr Crit Care Med , 2007, 8(2): S3-10.
26.	Despins LA. Patient Safety and Collaboration of the Intensive Care Unit Team. Crit Care Nurse , 2009, 29(2): 85-91.
27.	George EL, Henneman EA, Tasota FJ. Nursing implications for prevention of adverse drug events in the intensive care unit. Crit Care Med , 2010, 28(6): 136-144.
28.	Cohen MR. Healthcare Consumers: Essential Partners in Safe Medication Use(2008). [2011-1-17] Available from: URL: http://www.sciencedirect.com/.
29.	Sinopoli DJ, Needham DM, Thompson DA, et al . Intensive care unit safety incidents for medical versus surgical patients: A prospective multicenter study. J Crit Care , 2007, 22(3): 177-183.
30.	Robin CK. Improving Medication Safety in the NICU. [2011-1-17] Available from: URL: http://www.sciencedirect.com/.
31.	Rothschild JM, Landrigan CP, Cronin JW, et al . The Critical Care Safety Study: The incidence and nature of adverse events and serious medical errors in intensive care. Crit Care Med , 2005, 33(8): 1694-1700.
32.	The NPSA. Seven steps to patient safety. The full reference guide.[2010-5-12] Available from: URL: http://www.nrls.npsa.nhs.uk/resources/collections/seven-steps-to-patient-safety/.
33.	李幼平, 文進, 王莉. 藥品風險管理: 概念、原則、研究方法與實踐. 中國循證醫學雜志, 2007, 7(12): 843-848.

1. 1 Stahl K, Palileo A, Schulman CI, et al . Enhancing Patient Safety in the Trauma/Surgical Intensive Care Unit. J Trauma , 2009, 67(3): 430-435.
2. The Intensive Care Society. Standards for critical incident reporting in critical care (2006). [2011-1-17]Available from: URL: http://www.npsa.nhs.uk/health/resources.
3. Reader T, Flin R, Lauche K, et al . Non-Technical Skills in the Intensive Care Unit. [2011-1-17] Available from: URL: http://www.sciencedirect.com/.
4. Health Technology Assessment(HTA). The investigation and analysis of critical incidents and adverse events in healthcare(2005). [2011-1-17]Available from: URL: http://www.sciencedirect.com/.
5. Spigelman AD, Swan J. Review of the Australian incident monitoring system. ANZ J of Sur , 2005, 75(8): 657-661.
6. Wu AW, Pronovost P, Morlock L. ICU incident reporting systems. J Crit Care , 2002, 17(2): 86-94.
7. Holzmueller CG, Pronovost PJ, Dickman F, et al . Creating the Web-based Intensive Care Unit Safety Reporting System. J Am Med Inform Assoc , 2005, 12(2): 130-139.
8. Allan G. Improving the Intensive Care Unit. [2011-1-17] Available from: URL: http://www.sciencedirect.com/.
9. McCauley K, Irwin RS. Changing the Work Environment in ICUs to Achieve Patient-Focused Care. Chest , 2006, 130(5): 1571-1578.
10. Thomas AN, Pilkington CE, Greer R. Critical incident reporting in UK intensive care units: a postal survey. J Eval Clin Pract , 2003, 9(1): 59-68.
11. Scholefield H. Safety in obstetric critical care. Best Pract Res Clin Obstet Gynaecol , 2008, 22(5): 965-982.
12. Gunning KE. Critical incident reporting in Intensive Care. Intensive Care Med , 2000, 26(1): 8-10.
13. Pronovost PJ, Berenholtz SM, Goeschel C, et al . Improving patient safety in intensive care units in Michigan. J Crit Care , 2008, 23(2): 207-221.
14. Pronovost PJ, Morlock LL, Sexton JB, et al . Improving the Value of Patient Safety Reporting Systems. [2011-1-17] Available from: URL: http://www.sciencedirect.com/.
15. Lacey S, Smith JB, Cox K. Pediatric Safety and Quality. [2011-1-17] Available from: URL: http://www.sciencedirect.com/.
16. Suresh G, Horbar JD, Plsek P, et al . Voluntary Anonymous Reporting of Medical Errors for Neonatal Intensive Care. Pediatrics , 2004, 113(6): 1609-1618.
17. Baldwin I, Beckman U, Shaw L, et al . Australian Incident Monitoring Study in intensive care: local unit review meetings and report management. Anaesth Intensive Care , 1998, 26(3): 294-297.
18. Beckmann U, Baldwin I, Hart GK, et al . The Australian Incident Monitoring Study in Intensive Care: AIMS-ICU. Ananalysis of the first year of reporting. Anaesth Intensive Care , 1996, 24(3): 320-329.
19. Beckmann U, West LF, Groombridge GJ, et al . The Australian Incident Monitoring Study in Intensive Care: AIMS-ICU. The development and evaluation of an incident reporting system in intensive care. Anaesth Intensive Care , 1996, 24(3): 314-319.
20. Beckmann U, Bohringer C, Carless R, et al . Evaluation of two methods for quality improvement in intensive care: Facilitated incident monitoring and retrospective medical chart review. Critical Care Med , 2003, 31(4): 1006-1011.
21. Pronovost P, Goeschel C. Improving ICU Care: It Takes a Team. Healthc Exec , 2005, 20(2): 14-22.
22. Schuerer DJ, Nast PA, Harris CB, et al . A New Safety Event Reporting System Improves Physician Reporting in the Surgical Intensive Care Unit. J Am Coll Surg , 2006, 202(6): 881-887.
23. Donze A, Wolf M. St. Safety in the NICU Preventing Medication Errors with Computerized Provider Order Entry. Nurs Womens Health , 2007, 11(6): 612-617.
24. Hazlehurst B, McMullen C. Orienting frames and private routines: The role of cultural process in critical care safety. Int J Med Inform , 2007, 76(1): S129-135.
25. Scanlon MC, Mistry KP, Jeffries HE. Determining pediatric intensive care unit quality indicators for measuring pediatric intensive care unit safety. Pediatr Crit Care Med , 2007, 8(2): S3-10.
26. Despins LA. Patient Safety and Collaboration of the Intensive Care Unit Team. Crit Care Nurse , 2009, 29(2): 85-91.
27. George EL, Henneman EA, Tasota FJ. Nursing implications for prevention of adverse drug events in the intensive care unit. Crit Care Med , 2010, 28(6): 136-144.
28. Cohen MR. Healthcare Consumers: Essential Partners in Safe Medication Use(2008). [2011-1-17] Available from: URL: http://www.sciencedirect.com/.
29. Sinopoli DJ, Needham DM, Thompson DA, et al . Intensive care unit safety incidents for medical versus surgical patients: A prospective multicenter study. J Crit Care , 2007, 22(3): 177-183.
30. Robin CK. Improving Medication Safety in the NICU. [2011-1-17] Available from: URL: http://www.sciencedirect.com/.
31. Rothschild JM, Landrigan CP, Cronin JW, et al . The Critical Care Safety Study: The incidence and nature of adverse events and serious medical errors in intensive care. Crit Care Med , 2005, 33(8): 1694-1700.
32. The NPSA. Seven steps to patient safety. The full reference guide.[2010-5-12] Available from: URL: http://www.nrls.npsa.nhs.uk/resources/collections/seven-steps-to-patient-safety/.
33. 李幼平, 文進, 王莉. 藥品風險管理: 概念、原則、研究方法與實踐. 中國循證醫學雜志, 2007, 7(12): 843-848.

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