英美澳加和中国台湾地区ICU医疗风险管理分析_《中国循证医学杂志》

作者：

孙纽云 ¹ , 崔小花 ² ,  梁铭会 ¹ , 王莉 ² , 李幼平 ² , 成岚 ² , 李筱 ² , 袁强 ²

1. 卫生部医院管理研究所（北京 100083）；2. 四川大学华西医院中国循证医学中心（成都 610041）;

关键词：

医疗风险 ICU 风险管理

DOI：

10.7507/1672-2531.20110062

视频：

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摘要 全文 图表 视频 参考文献 施引文献 补充材料

目的　比较分析美、英、加、澳和中国台湾地区医疗风险与预警监测系统管理模式，为我国医疗风险管理提供决策依据和政策建议。
方法　检索上述四国一区医疗风险管理相关机构官方网站（截止至2010年12月），纳入规范性文件、学术研究报告、综述、官网一般信息等，详细筛选和提取相关资料，并按不同主题进行描述性分析。
结果　① 共纳入142篇文献，美国文献量最大（68篇），质量较高的规范性文件也最多（8篇）。② 四国一区上报系统随启动时间长短，上报事件类型、范围不断扩展，从最初用药差错/医院感染事件扩展到近似差错事件，目前已囊括全部病人安全事件。③ 国家层面的管理模式可归纳为两个体系，即以英国为代表的国家主导模式和以美、加、澳为代表的法律/法规/行业协会协同模式。两种模式在法律/法规、标准化、规范化、资金来源等方面均有自身突出优点。④ 为特别需求设立的国家级系统分两类，即造成死亡或严重伤害的事件上报系统（包括美国警讯事件数据库和英国严重事件报告与学习框架）及医院感染事件监测系统（美国全国医疗安全网）。其针对性较强，有利于特殊事件的监测、处理和预警。⑤ 国家二级政府系统的比较研究选取美国印第安纳州政府强制报告内容和程序与中国台湾病人安全通报系统。后者对事件对象、上报内容定位更广泛系统，兼顾风险管理各环节，值得借鉴；⑥ 比较四国一区总体上报事件结果表明：目前英国系统最完善，加拿大系统需发展完善的环节最多。
结论　① 英国医疗风险管理系统为国家主导的中央集权管理，是目前最完备的系统；② 美国系统启动最早，虽管理范围局限，但依靠其相对最完善的法律/法规保障，仍能有效发挥作用；③ 加、澳两国借鉴美、英经验，仍在不断发展完善中；④ 中国台湾地区系统比美国印第安纳州政府系统各方面内容更充实，可操作性更强，值得借鉴。目的　通过分析四国一区ICU风险管理政策指南、机构管理和运行机制等，为我国ICU风险管理提供决策依据和政策建议。
方法　计算机检索PubMed,、EMbase, Cochrane Library等数据库，纳入美国、英国、加拿大、澳大利亚和中国台湾地区ICU风险管理相关指南、研究报告等文献，综合分析四国一区风险管理的机构和运行机制，并重点关注英国模式。
结果　共纳入31篇文献，包括1篇指南、5篇综述、2篇调查报告和23篇研究。英国以标准和指南形式指导ICU风险管理，制定明确的事件分级工具和相应响应机制。美国借鉴澳大利亚经验建立了ICU安全报告系统，二者均将ICU作为整个医疗风险管理的一部分，设立专门的管理板块。
结论　英国将ICU风险管理纳入国家病人安全管理范围，单独设立报告系统，是目前较完备的系统。澳、美由国家机构设立ICU风险管理研究项目，行业协会和非政府组织主导风险研究，由试点单位使用后逐步推广使用。

引用本文： 孙纽云,崔小花,梁铭会,王莉,李幼平,成岚,李筱,袁强. 英美澳加和中国台湾地区ICU医疗风险管理分析. 中国循证医学杂志, 2011, 11(4): 357-366. doi: 10.7507/1672-2531.20110062 复制

1.	1 Stahl K, Palileo A, Schulman CI, et al . Enhancing Patient Safety in the Trauma/Surgical Intensive Care Unit. J Trauma , 2009, 67(3): 430-435.
2.	The Intensive Care Society. Standards for critical incident reporting in critical care (2006). [2011-1-17]Available from: URL: http://www.npsa.nhs.uk/health/resources.
3.	Reader T, Flin R, Lauche K, et al . Non-Technical Skills in the Intensive Care Unit. [2011-1-17] Available from: URL: http://www.sciencedirect.com/.
4.	Health Technology Assessment(HTA). The investigation and analysis of critical incidents and adverse events in healthcare(2005). [2011-1-17]Available from: URL: http://www.sciencedirect.com/.
5.	Spigelman AD, Swan J. Review of the Australian incident monitoring system. ANZ J of Sur , 2005, 75(8): 657-661.
6.	Wu AW, Pronovost P, Morlock L. ICU incident reporting systems. J Crit Care , 2002, 17(2): 86-94.
7.	Holzmueller CG, Pronovost PJ, Dickman F, et al . Creating the Web-based Intensive Care Unit Safety Reporting System. J Am Med Inform Assoc , 2005, 12(2): 130-139.
8.	Allan G. Improving the Intensive Care Unit. [2011-1-17] Available from: URL: http://www.sciencedirect.com/.
9.	McCauley K, Irwin RS. Changing the Work Environment in ICUs to Achieve Patient-Focused Care. Chest , 2006, 130(5): 1571-1578.
10.	Thomas AN, Pilkington CE, Greer R. Critical incident reporting in UK intensive care units: a postal survey. J Eval Clin Pract , 2003, 9(1): 59-68.
11.	Scholefield H. Safety in obstetric critical care. Best Pract Res Clin Obstet Gynaecol , 2008, 22(5): 965-982.
12.	Gunning KE. Critical incident reporting in Intensive Care. Intensive Care Med , 2000, 26(1): 8-10.
13.	Pronovost PJ, Berenholtz SM, Goeschel C, et al . Improving patient safety in intensive care units in Michigan. J Crit Care , 2008, 23(2): 207-221.
14.	Pronovost PJ, Morlock LL, Sexton JB, et al . Improving the Value of Patient Safety Reporting Systems. [2011-1-17] Available from: URL: http://www.sciencedirect.com/.
15.	Lacey S, Smith JB, Cox K. Pediatric Safety and Quality. [2011-1-17] Available from: URL: http://www.sciencedirect.com/.
16.	Suresh G, Horbar JD, Plsek P, et al . Voluntary Anonymous Reporting of Medical Errors for Neonatal Intensive Care. Pediatrics , 2004, 113(6): 1609-1618.
17.	Baldwin I, Beckman U, Shaw L, et al . Australian Incident Monitoring Study in intensive care: local unit review meetings and report management. Anaesth Intensive Care , 1998, 26(3): 294-297.
18.	Beckmann U, Baldwin I, Hart GK, et al . The Australian Incident Monitoring Study in Intensive Care: AIMS-ICU. Ananalysis of the first year of reporting. Anaesth Intensive Care , 1996, 24(3): 320-329.
19.	Beckmann U, West LF, Groombridge GJ, et al . The Australian Incident Monitoring Study in Intensive Care: AIMS-ICU. The development and evaluation of an incident reporting system in intensive care. Anaesth Intensive Care , 1996, 24(3): 314-319.
20.	Beckmann U, Bohringer C, Carless R, et al . Evaluation of two methods for quality improvement in intensive care: Facilitated incident monitoring and retrospective medical chart review. Critical Care Med , 2003, 31(4): 1006-1011.
21.	Pronovost P, Goeschel C. Improving ICU Care: It Takes a Team. Healthc Exec , 2005, 20(2): 14-22.
22.	Schuerer DJ, Nast PA, Harris CB, et al . A New Safety Event Reporting System Improves Physician Reporting in the Surgical Intensive Care Unit. J Am Coll Surg , 2006, 202(6): 881-887.
23.	Donze A, Wolf M. St. Safety in the NICU Preventing Medication Errors with Computerized Provider Order Entry. Nurs Womens Health , 2007, 11(6): 612-617.
24.	Hazlehurst B, McMullen C. Orienting frames and private routines: The role of cultural process in critical care safety. Int J Med Inform , 2007, 76(1): S129-135.
25.	Scanlon MC, Mistry KP, Jeffries HE. Determining pediatric intensive care unit quality indicators for measuring pediatric intensive care unit safety. Pediatr Crit Care Med , 2007, 8(2): S3-10.
26.	Despins LA. Patient Safety and Collaboration of the Intensive Care Unit Team. Crit Care Nurse , 2009, 29(2): 85-91.
27.	George EL, Henneman EA, Tasota FJ. Nursing implications for prevention of adverse drug events in the intensive care unit. Crit Care Med , 2010, 28(6): 136-144.
28.	Cohen MR. Healthcare Consumers: Essential Partners in Safe Medication Use(2008). [2011-1-17] Available from: URL: http://www.sciencedirect.com/.
29.	Sinopoli DJ, Needham DM, Thompson DA, et al . Intensive care unit safety incidents for medical versus surgical patients: A prospective multicenter study. J Crit Care , 2007, 22(3): 177-183.
30.	Robin CK. Improving Medication Safety in the NICU. [2011-1-17] Available from: URL: http://www.sciencedirect.com/.
31.	Rothschild JM, Landrigan CP, Cronin JW, et al . The Critical Care Safety Study: The incidence and nature of adverse events and serious medical errors in intensive care. Crit Care Med , 2005, 33(8): 1694-1700.
32.	The NPSA. Seven steps to patient safety. The full reference guide.[2010-5-12] Available from: URL: http://www.nrls.npsa.nhs.uk/resources/collections/seven-steps-to-patient-safety/.
33.	李幼平, 文进, 王莉. 药品风险管理: 概念、原则、研究方法与实践. 中国循证医学杂志, 2007, 7(12): 843-848.

1. 1 Stahl K, Palileo A, Schulman CI, et al . Enhancing Patient Safety in the Trauma/Surgical Intensive Care Unit. J Trauma , 2009, 67(3): 430-435.
2. The Intensive Care Society. Standards for critical incident reporting in critical care (2006). [2011-1-17]Available from: URL: http://www.npsa.nhs.uk/health/resources.
3. Reader T, Flin R, Lauche K, et al . Non-Technical Skills in the Intensive Care Unit. [2011-1-17] Available from: URL: http://www.sciencedirect.com/.
4. Health Technology Assessment(HTA). The investigation and analysis of critical incidents and adverse events in healthcare(2005). [2011-1-17]Available from: URL: http://www.sciencedirect.com/.
5. Spigelman AD, Swan J. Review of the Australian incident monitoring system. ANZ J of Sur , 2005, 75(8): 657-661.
6. Wu AW, Pronovost P, Morlock L. ICU incident reporting systems. J Crit Care , 2002, 17(2): 86-94.
7. Holzmueller CG, Pronovost PJ, Dickman F, et al . Creating the Web-based Intensive Care Unit Safety Reporting System. J Am Med Inform Assoc , 2005, 12(2): 130-139.
8. Allan G. Improving the Intensive Care Unit. [2011-1-17] Available from: URL: http://www.sciencedirect.com/.
9. McCauley K, Irwin RS. Changing the Work Environment in ICUs to Achieve Patient-Focused Care. Chest , 2006, 130(5): 1571-1578.
10. Thomas AN, Pilkington CE, Greer R. Critical incident reporting in UK intensive care units: a postal survey. J Eval Clin Pract , 2003, 9(1): 59-68.
11. Scholefield H. Safety in obstetric critical care. Best Pract Res Clin Obstet Gynaecol , 2008, 22(5): 965-982.
12. Gunning KE. Critical incident reporting in Intensive Care. Intensive Care Med , 2000, 26(1): 8-10.
13. Pronovost PJ, Berenholtz SM, Goeschel C, et al . Improving patient safety in intensive care units in Michigan. J Crit Care , 2008, 23(2): 207-221.
14. Pronovost PJ, Morlock LL, Sexton JB, et al . Improving the Value of Patient Safety Reporting Systems. [2011-1-17] Available from: URL: http://www.sciencedirect.com/.
15. Lacey S, Smith JB, Cox K. Pediatric Safety and Quality. [2011-1-17] Available from: URL: http://www.sciencedirect.com/.
16. Suresh G, Horbar JD, Plsek P, et al . Voluntary Anonymous Reporting of Medical Errors for Neonatal Intensive Care. Pediatrics , 2004, 113(6): 1609-1618.
17. Baldwin I, Beckman U, Shaw L, et al . Australian Incident Monitoring Study in intensive care: local unit review meetings and report management. Anaesth Intensive Care , 1998, 26(3): 294-297.
18. Beckmann U, Baldwin I, Hart GK, et al . The Australian Incident Monitoring Study in Intensive Care: AIMS-ICU. Ananalysis of the first year of reporting. Anaesth Intensive Care , 1996, 24(3): 320-329.
19. Beckmann U, West LF, Groombridge GJ, et al . The Australian Incident Monitoring Study in Intensive Care: AIMS-ICU. The development and evaluation of an incident reporting system in intensive care. Anaesth Intensive Care , 1996, 24(3): 314-319.
20. Beckmann U, Bohringer C, Carless R, et al . Evaluation of two methods for quality improvement in intensive care: Facilitated incident monitoring and retrospective medical chart review. Critical Care Med , 2003, 31(4): 1006-1011.
21. Pronovost P, Goeschel C. Improving ICU Care: It Takes a Team. Healthc Exec , 2005, 20(2): 14-22.
22. Schuerer DJ, Nast PA, Harris CB, et al . A New Safety Event Reporting System Improves Physician Reporting in the Surgical Intensive Care Unit. J Am Coll Surg , 2006, 202(6): 881-887.
23. Donze A, Wolf M. St. Safety in the NICU Preventing Medication Errors with Computerized Provider Order Entry. Nurs Womens Health , 2007, 11(6): 612-617.
24. Hazlehurst B, McMullen C. Orienting frames and private routines: The role of cultural process in critical care safety. Int J Med Inform , 2007, 76(1): S129-135.
25. Scanlon MC, Mistry KP, Jeffries HE. Determining pediatric intensive care unit quality indicators for measuring pediatric intensive care unit safety. Pediatr Crit Care Med , 2007, 8(2): S3-10.
26. Despins LA. Patient Safety and Collaboration of the Intensive Care Unit Team. Crit Care Nurse , 2009, 29(2): 85-91.
27. George EL, Henneman EA, Tasota FJ. Nursing implications for prevention of adverse drug events in the intensive care unit. Crit Care Med , 2010, 28(6): 136-144.
28. Cohen MR. Healthcare Consumers: Essential Partners in Safe Medication Use(2008). [2011-1-17] Available from: URL: http://www.sciencedirect.com/.
29. Sinopoli DJ, Needham DM, Thompson DA, et al . Intensive care unit safety incidents for medical versus surgical patients: A prospective multicenter study. J Crit Care , 2007, 22(3): 177-183.
30. Robin CK. Improving Medication Safety in the NICU. [2011-1-17] Available from: URL: http://www.sciencedirect.com/.
31. Rothschild JM, Landrigan CP, Cronin JW, et al . The Critical Care Safety Study: The incidence and nature of adverse events and serious medical errors in intensive care. Crit Care Med , 2005, 33(8): 1694-1700.
32. The NPSA. Seven steps to patient safety. The full reference guide.[2010-5-12] Available from: URL: http://www.nrls.npsa.nhs.uk/resources/collections/seven-steps-to-patient-safety/.
33. 李幼平, 文进, 王莉. 药品风险管理: 概念、原则、研究方法与实践. 中国循证医学杂志, 2007, 7(12): 843-848.

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英美澳加和中国台湾地区ICU医疗风险管理分析

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