比较转入重症监护病房和普通病房患者的投诉：在台湾一所教学医院使用医疗保健投诉分析工具进行的分析。
Comparison of complaints to the intensive care units and those to the general wards: an analysis using the Healthcare Complaint Analysis Tool in an academic medical center in Taiwan.
机构信息
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan.
出版信息
Crit Care. 2018 Dec 6;22(1):335. doi: 10.1186/s13054-018-2271-y.
BACKGROUND
The management of complaints in the setting of intensive care may provide opportunities to understand patient and family experiences and needs. However, there are limited reports on the structured application of complaint analysis tools and comparisons between healthcare complaints in the critical care setting and other settings.
METHODS
From the complaint management database of a university-affiliated medical center in Taiwan, we retrospectively identified the records of healthcare complaints to the intensive care units (ICUs) from 2008 to 2016. Complaints to the general wards in the same period were randomly selected from the database with twice the number of that of the ICU complaints. We coded, typed, and compared the complaints from the two settings according to the Healthcare Complaint Analysis Tool.
RESULTS
We identified 343 complaints to the ICUs and randomly selected 686 complaints to the general wards during the 9-year study period. Most (94.7%) of the complaints to the ICUs came from the family members, whereas more complaints to the general wards came from the patients (44.2%). A total of 1529 problems (441 from ICU and 818 from general wards) were identified. Compared with the general ward complaints, in the ICU there were more complaints with multiple problems (25.1% vs. 16.9%, p = 0.002), complaints were referred more frequently to the nurses (28.1% vs. 17.5%, p < 0.001), and they focused more commonly on the care on the ICU/ward (60.5% vs. 54.2%, p = 0.029). The proportions of the three domains (clinical, management, and relationship) of complaints were similar between the ICU and general ward complaints (p = 0.121). However, in the management domain, the problems from ICU complaints focused more on the environment than on the institutional processes (90.9% vs. 74.5%, p < 0.001), whereas in the relationship domain, the problems focused more on communication (17.9% vs. 8.0%) and less on listening (34.6% vs. 46.5%) (p = 0.002) than the general ward complaints.
CONCLUSIONS
A structured typing and systematic analysis of the healthcare complaints to the ICUs may provide valuable insights into the improvement of care quality, especially to the perceptions of the ICU environment and communications of the patients and their families.
背景
在重症监护环境中处理投诉可提供了解患者和家属体验和需求的机会。然而，关于投诉分析工具的结构化应用以及重症监护环境与其他环境中的医疗保健投诉之间的比较，报告十分有限。
方法
我们从中国台湾一家大学附属医院的投诉管理数据库中，回顾性地确定了 2008 年至 2016 年期间向重症监护病房（ICU）提出的医疗保健投诉记录。同期，我们从数据库中随机选择了两倍于 ICU 投诉数量的 ICU 病房投诉。我们根据医疗保健投诉分析工具对这两个环境中的投诉进行了编码、分类和比较。
结果
在 9 年的研究期间，我们共确定了 343 例向 ICU 提出的投诉，并随机选择了 686 例向普通病房提出的投诉。大多数（94.7%）向 ICU 提出的投诉来自家属，而更多的向普通病房提出的投诉来自患者（44.2%）。共确定了 1529 个问题（ICU 有 441 个，普通病房有 818 个）。与普通病房的投诉相比，在 ICU 中，有更多的投诉涉及多个问题（25.1%比 16.9%，p=0.002），向护士投诉的情况更为常见（28.1%比 17.5%，p<0.001），而且更关注 ICU/病房的护理（60.5%比 54.2%，p=0.029）。ICU 投诉和普通病房投诉的投诉的三个领域（临床、管理和关系）的比例相似（p=0.121）。然而，在管理领域，来自 ICU 投诉的问题更关注环境而非机构流程（90.9%比 74.5%，p<0.001），而在关系领域，问题更关注沟通（17.9%比 8.0%），而倾听问题则较少（34.6%比 46.5%）（p=0.002）。
结论
对 ICU 患者的医疗保健投诉进行结构化分类和系统分析，可为提高护理质量提供有价值的见解，特别是对 ICU 环境以及患者及其家属的沟通感知。
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