Thommen P J, Emery R J
The University of Texas School of Public Health, 1200 Herman Pressler, Houston, TX 77030, USA.
Health Phys. 2006 May;90(5 Suppl):S62-6. doi: 10.1097/01.HP.0000202231.88465.6a.
In an effort to reveal the possible underlying causes of radiation-related health care complaints in the State of Texas, complaint data were evaluated using historical Texas Department of Health-Bureau of Radiation Control (TDH-BRC) reports. A major aim of the study was to generate a summary of the most commonly reported complaints that might be generalized to health care providers using sources of radiation across Texas. A generalizable list of common complaints would be a valuable tool for education and prevention programs, serving to possibly reduce the overall incidence of radiation-related medical complaints. Descriptive text summary reports of complaints were obtained from the TDH-BRC for the 20-y period inclusive of 1981 to 2001. The information was systematically coded into a computerized database. During the 20-y period of study, 481 health care-related complaints were identified, with approximately 74% consisting of claims of an "uncredentialed technician" (39%), "overexposure" (21%), or "regulatory violation" (14%). The most common categories of complaints imply some patient understanding or knowledge of the credentialing requirements of workers, the applicable dose limits, or the regulatory requirements associated with medical procedures. Since it is unlikely that an average patient would be aware of such issues, the findings suggest the complaints are not actually indications of the inappropriate uses of radiation, but are rather based on the patient's broader perception of services rendered. Most of the complaints levied during the period of study were done so anonymously (58%) and were levied against a generic facility (61%) rather than a specific technician (5%), doctor (4%), or student (1%). Approximately 61% of the complaints resulted in the issuance of a notice of violation upon investigation by the TDH-BRC, but the available data did not permit definitive linkage between the initial complaint and the violation issued. Taken in aggregate, the analysis suggests that improved communications between health care providers and the patients they serve could possibly serve to prevent future complaints. Although the analysis was limited to the data from a single state, the results may be of use to quality assurance programs on a broader scale because of the objective identification of likely common issues. Possible options for improving the means of systematically collecting initial compliant data in the future are also discussed.
为了揭示得克萨斯州与辐射相关的医疗保健投诉可能的潜在原因，利用得克萨斯州卫生部辐射控制局（TDH - BRC）的历史报告对投诉数据进行了评估。该研究的一个主要目的是总结最常报告的投诉，这些投诉可能适用于得克萨斯州各地使用辐射源的医疗保健提供者。一份通用的常见投诉清单对于教育和预防项目将是一个有价值的工具，可能有助于降低与辐射相关的医疗投诉的总体发生率。从TDH - BRC获取了1981年至2001年这20年期间投诉的描述性文本总结报告。这些信息被系统地编码到一个计算机化数据库中。在为期20年的研究期间，共确定了481起与医疗保健相关的投诉，其中约74%包括“无资质技术员”（39%）、“过度暴露”（21%）或“违规”（14%）的指控。最常见的投诉类别意味着患者对工作人员的资质要求、适用的剂量限制或与医疗程序相关的监管要求有一定的理解或认识。由于普通患者不太可能了解这些问题，研究结果表明这些投诉实际上并非辐射不当使用的迹象，而是基于患者对所提供服务的更广泛认知。在研究期间提出的大多数投诉是匿名的（58%），并且是针对一般机构（61%），而不是特定的技术员（5%）、医生（4%）或学生（1%）。TDH - BRC调查后，约61%的投诉导致发出违规通知，但现有数据无法确定最初投诉与发出的违规之间的明确联系。总体而言，分析表明改善医疗保健提供者与其服务患者之间的沟通可能有助于防止未来的投诉。尽管分析仅限于来自单个州的数据，但由于客观识别了可能的常见问题，结果可能在更广泛的范围内对质量保证项目有用。还讨论了未来改进系统收集初始投诉数据方式的可能选项。
