Lee Ching-Yi, Lai Hung-Yi, Lee Ching-Hsin, Chen Mi-Mi
Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Taoyuan 333423, Taiwan.
College of Medicine, Chang Gung University, Taoyuan 333323, Taiwan.
Healthcare (Basel). 2022 Nov 7;10(11):2224. doi: 10.3390/healthcare10112224.
Studies that examine medical dispute cases (MDC) due to clinical reasoning (CR) are scarce in Taiwan. A retrospective analysis was undertaken to review MDC filed at four hospitals in Taiwan between 2011 and 2015. Cases were examined for the healthcare professionals involved, their relevance to CR errors, clinical specialties, and seniority. Seventy-eight MDC were identified and 57.7% of which were determined to be related to CR errors (n = 45). Among the 45 cases associated with CR errors, 82.2% (37) and 22.2% (10) were knowledge- and skill-related errors, respectively. The healthcare professionals with the most MDC were obstetrician-gynecologists (10/90, 11.1%), surgeons (8/90, 8.9%), and emergency physicians (7/90, 7.8%). The seniority of less than 5 years or lower had the highest number of attending physicians to be associated with MDC. In contrast, the highest seniority (>25 years) in the physician group and year 6 in the resident group are both shown with zero MDC. In our study, the larger hospitals had a significantly higher incidence of MDC compared to the smaller hospitals (Pearson Correlation Coefficient = 0.984, p = 0.016). An examination of MDC reveals the frequency and nature of medical errors in Taiwanese hospitals. Having identified that CR errors contributed a substantial fraction to the overall MDC, strategies to promote reasoning skills and hence reduce medico-legal issues help safeguard both patients and healthcare professionals.
在台湾，针对因临床推理导致的医疗纠纷案件进行研究的情况较为少见。我们进行了一项回顾性分析，以审查2011年至2015年期间台湾四家医院提交的医疗纠纷案件。对涉及的医疗专业人员、他们与临床推理错误的相关性、临床专科以及资历进行了审查。共识别出78起医疗纠纷案件，其中57.7%（n = 45）被确定与临床推理错误有关。在这45起与临床推理错误相关的案件中，分别有82.2%（37起）和22.2%（10起）是与知识和技能相关的错误。涉及医疗纠纷案件最多的医疗专业人员是妇产科医生（10/90，11.1%）、外科医生（8/90，8.9%）和急诊科医生（7/90，7.8%）。资历不足5年或更低的主治医生与医疗纠纷案件关联的数量最多。相比之下，医生组中资历最高（>25年）以及住院医师组中第6年的医生与医疗纠纷案件的关联数均为零。在我们的研究中，大型医院的医疗纠纷案件发生率明显高于小型医院（皮尔逊相关系数 = 0.984，p = 0.016）。对医疗纠纷案件的审查揭示了台湾医院医疗错误的频率和性质。鉴于已确定临床推理错误在整体医疗纠纷案件中占很大比例，提升推理技能从而减少医疗法律问题的策略有助于保护患者和医疗专业人员。
