2016 年至 2017 年中国骨科医生医疗纠纷案件特征。
Characteristics of the medical malpractice cases against orthopedists in China between 2016 and 2017.
机构信息
Department of Journal Center, The Third Hospital of Hebei Medical University, Shijiazhuang, China.
Office of Orthopedic Clinical Medicine Research Center, The Third Hospital of Hebei Medical University, Shijiazhuang, China.
出版信息
PLoS One. 2021 May 12;16(5):e0248052. doi: 10.1371/journal.pone.0248052. eCollection 2021.
BACKGROUND
This study aimed to identify the most frequent reasons for orthopedic medical malpractice, gain insight into the related patient demographics and clinical characteristics, and identify the independent factors associated with it.
METHODS
We collected and analyzed the demographic and injury characteristics, hospital levels and treatments, medical errors, and orthopedist's degree of responsibility for the patients who were subject to orthopedic medical malpractice at our institution. Univariate and multivariate analyses were performed to identify the factors associated with the orthopedist's degree of responsibility in the medical malpractice cases.
RESULTS
We included 1922 cases of medical malpractice in the final analysis. There were 1195 and 727 men and women, respectively (62.2% and 37.8%, respectively). Of the total patients, 1810, 1038, 1558, 1441, and 414 patients (94.2%, 54.0%, 81.1%, 75.0%, and 21.5%, respectively) were inpatients, had closed injuries, underwent surgery, were trauma cases, and had preoperative comorbidities, respectively. Most medical malpractice cases were in patients with fractures and spinal degenerative disease (1229 and 253 cases; 63.9% and 13.2%, respectively), and occurred in city-level hospitals (1006 cases, 52.3%), which were located in the eastern part of china (1001, 52.1%), including Jiangsu and Zhejiang (279 and 233 cases, 14.52% and 52.1%, respectively). Between 2016 and 2017, the orthopedist's degree of responsibility in medical malpractice claims were deemed as full, primary, equal, secondary, and minor in 135, 654, 77, 716, and 340 orthopedists (7.0%, 34.0%, 4.0%, 37.3%, and 17.7%). Most medical errors made by orthopedists in cases of medical malpractice were related to failure to supervise or monitor cases, improper performance of procedures, and failure to instruct or communicate with the patient (736, 716, and 423 cases; 38.3%, 37.3%, and 22.0%, respectively). The multivariate analysis found that patients with preoperative comorbidities, who sustained humerus injuries, who were aged ≥65 years, who were treated by doctors who failed to supervise or monitor them, and who were treated at the provincial and city level hospitals were more likely to claim that the orthopedist bore a serious degree of responsibility in the medical malpractice case.
CONCLUSIONS
Our results provide detailed information on the plaintiff demographics, clinical characteristics, and factors associated with medical malpractice. Medical malpractice is related to poor treatment outcomes. The first preventative measure that is required is a comprehensive improvement in the medical staff quality, mainly through medical ethics cultivation, and professional ability and technique training. Additionally, failure to supervise or monitor cases was the leading cause of medical malpractice and one of the factors that led to orthopedists bearing an equal and higher responsibility for medical malpractice. Orthopedists should improve patient supervision, especially when treating older patients and those with preoperative comorbidities and humerus injuries.
背景
本研究旨在确定骨科医疗事故最常见的原因，深入了解相关患者的人口统计学和临床特征，并确定与之相关的独立因素。
方法
我们收集并分析了我院骨科医疗事故患者的人口统计学和损伤特征、医院级别和治疗方法、医疗差错以及骨科医生的责任程度。采用单因素和多因素分析方法，确定与骨科医生在医疗事故中责任程度相关的因素。
结果
我们最终纳入了 1922 例医疗事故。其中男性和女性分别为 1195 例和 727 例（分别占 62.2%和 37.8%）。在所有患者中，分别有 1810 例、1038 例、1558 例、1441 例和 414 例（分别占 94.2%、54.0%、81.1%、75.0%和 21.5%）为住院患者、闭合性损伤、接受手术、创伤病例和术前合并症患者。大多数医疗事故发生在骨折和脊柱退行性疾病患者中（1229 例和 253 例；分别占 63.9%和 13.2%），发生在市级医院（1006 例，占 52.3%），位于中国东部（1001 例，占 52.1%），包括江苏和浙江（279 例和 233 例；分别占 14.52%和 52.1%）。在 2016 年至 2017 年期间，135 名骨科医生的责任程度被认定为全责、主要责任、同等责任、次要责任和轻微责任，654 名骨科医生被认定为主要责任、77 名骨科医生被认定为同等责任、716 名骨科医生被认定为次要责任、340 名骨科医生被认定为轻微责任（分别占 7.0%、34.0%、4.0%、37.3%和 17.7%）。骨科医生在医疗事故中最常见的医疗差错是未能监督或监测病例、程序不当执行以及未能指导或与患者沟通（分别为 736 例、716 例和 423 例；分别占 38.3%、37.3%和 22.0%）。多因素分析发现，术前合并症、肱骨干骨折、年龄≥65 岁、未接受监督或监测的医生治疗以及在省级和市级医院治疗的患者，更有可能在医疗事故中声称骨科医生承担严重的责任程度。
结论
我们的结果提供了有关原告人口统计学、临床特征和与医疗事故相关因素的详细信息。医疗事故与不良治疗结果有关。首先需要采取的预防措施是全面提高医务人员的素质，主要是通过医学伦理培养、专业能力和技术培训。此外，未能监督或监测病例是医疗事故的主要原因之一，也是导致骨科医生承担同等和更高责任的因素之一。骨科医生应加强对患者的监督，尤其是在治疗老年患者和有术前合并症以及肱骨干骨折的患者时。
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