エラー報告と開示システム:病院のリーダーからの見解
Joel S Weissman1, Catherine L Annas, Arnold M Epstein
1Institute for Health Policy, Massachusetts General Hospital, Boston 02114, USA. jweissman@partners.org
JAMA
|March 17, 2005
まとめ
病院の幹部は,報告制度の義務化によって訴訟が増加し,内部エラーの報告が減り,患者の安全に影響を及ぼすと懸念しています. 彼らは,軽い傷害よりも,深刻な傷害を州に報告する可能性が高い.
科学分野:
- 保健医療政策について
- 患者の安全性に関する研究
- 医療サービス 研究 医療サービス
背景:
- インスティテュート・オブ・メディシン (Institute of Medicine) は,医療におけるエラー報告システムを義務付けるよう推奨しています.
- 義務的な報告システムは,患者の安全と説明責任を改善することを目的としています.
研究 の 目的:
- 病院の指導者の国家義務付けのエラー報告システムに対する見解を評価する.
- これらのシステムの内部報告,訴訟,患者の安全に対する知覚された影響を理解する.
主な方法:
- 病院の最高経営責任者 (CEO) と最高経営責任者 (COO) を対象に調査が行われました.
- 病院は,異なる報告義務と公開ポリシーを持つ州から選択されました.
- 回答者は,報告の可能性を測るため,仮説的な臨床シナリオを評価した.
主要な成果:
- 大多数のリーダーは,強制的で機密でないシステムが内部報告を抑止し,訴訟を増加させると信じていました.
- ほとんどの指導者は,病院と専門家の機密性を好みましたが,公的開示の州は,病院の名前を公開するより大きな意思を示しました.
- 患者の重篤な怪我を州に報告する人の割合は90%以上だが,中度または軽度の怪我を報告する人は少ない.
結論:
- 病院の指導者は,強制的で機密でない報告システムの内部報告,訴訟,患者の安全に対する影響について重大な懸念を表明しました.
- 患者情報の開示を支持する一方で,指導者は,より軽度の事件を州システムに報告する傾向が低い.
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