医疗差错；原因、后果、情绪反应及由此产生的行为变化。
Medical errors; causes, consequences, emotional response and resulting behavioral change.
作者信息
Bari Attia, Khan Rehan Ahmed, Rathore Ahsan Waheed
机构信息
Dr. Attia Bari, MBBS, DCH, MCPS, FCPS. Associate Professor of Pediatric Medicine, Department of Pediatric Medicine, The Children's Hospital and The Institute of Child Health, Lahore, Pakistan.
Rehan Ahmed Khan, MBBS, FCPS, FRCS, JM-HPE, MSc HPE. Associate Professor of Surgery, Islamic International Medical College, Riphah University, Pakistan.
出版信息
Pak J Med Sci. 2016 May-Jun;32(3):523-8. doi: 10.12669/pjms.323.9701.
OBJECTIVE
To determine the causes of medical errors, the emotional and behavioral response of pediatric medicine residents to their medical errors and to determine their behavior change affecting their future training.
METHODS
One hundred thirty postgraduate residents were included in the study. Residents were asked to complete questionnaire about their errors and responses to their errors in three domains: emotional response, learning behavior and disclosure of the error. The names of the participants were kept confidential. Data was analyzed using SPSS version 20.
RESULTS
A total of 130 residents were included. Majority 128(98.5%) of these described some form of error. Serious errors that occurred were 24(19%), 63(48%) minor, 24(19%) near misses,2(2%) never encountered an error and 17(12%) did not mention type of error but mentioned causes and consequences. Only 73(57%) residents disclosed medical errors to their senior physician but disclosure to patient's family was negligible 15(11%). Fatigue due to long duty hours 85(65%), inadequate experience 66(52%), inadequate supervision 58(48%) and complex case 58(45%) were common causes of medical errors. Negative emotions were common and were significantly associated with lack of knowledge (p=0.001), missing warning signs (p=<0.001), not seeking advice (p=0.003) and procedural complications (p=0.001). Medical errors had significant impact on resident's behavior; 119(93%) residents became more careful, increased advice seeking from seniors 109(86%) and 109(86%) started paying more attention to details. Intrinsic causes of errors were significantly associated with increased information seeking behavior and vigilance (p=0.003) and (p=0.01) respectively.
CONCLUSION
Medical errors committed by residents have inadequate disclosure to senior physicians and result in negative emotions but there was positive change in their behavior, which resulted in improvement in their future training and patient care.
目的
确定医疗差错的原因、儿科住院医师对其医疗差错的情绪和行为反应，并确定影响其未来培训的行为变化。
方法
130名研究生住院医师纳入本研究。要求住院医师完成关于其差错及在三个方面对差错反应的问卷：情绪反应、学习行为和差错披露。参与者姓名保密。使用SPSS 20版分析数据。
结果
共纳入130名住院医师。其中大多数128名（98.5%）描述了某种形式的差错。发生的严重差错有24名（19%），轻微差错63名（48%），险些发生的差错24名（19%），2名（2%）从未遇到差错，17名（12%）未提及差错类型但提到了原因和后果。仅73名（57%）住院医师向其上级医师披露了医疗差错，但向患者家属披露的情况可忽略不计，为15名（11%）。长时间值班导致的疲劳85名（65%）、经验不足66名（52%）、监督不足58名（48%）和病例复杂58名（45%）是医疗差错的常见原因。负面情绪很常见，且与知识缺乏（p=0.001）、未注意到警示信号（p<0.001）、未寻求建议（p=0.003）和程序并发症（p=0.001）显著相关。医疗差错对住院医师的行为有显著影响；119名（93%）住院医师变得更加谨慎，向年长者寻求建议的人数增加109名（86%），109名（86%）开始更加关注细节。差错的内在原因分别与增加信息寻求行为（p=0.003）和提高警惕性（p=0.01）显著相关。
结论
住院医师所犯医疗差错向上级医师披露不足，并导致负面情绪，但他们的行为有积极变化，这使其未来培训和患者护理得到改善。
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