Objective To provide reference for medical risk management by systematically reviewing the hterature on aviation risk management abroad. Methods We searched the SCOPUS database and related websites, and handsearched related journals, for literatures on the history, experience, and models of aviation risk management, and their relationship to medical risk management. Rationale and method of evidence-based science were used to appraise and analyze the included hterature. Results Aviation and medical industry were both with the characteristics of high technology, high risk, and high professional. The aviation risk management system including the unique information reporting system, risk analyzing tools and models covered the whole process of information collecting, analyzing and managing, and with the emphasis on systematical construction. Conclusions Medical risk management in China should base on its own characteristics, taking the following experiences from aviation risk management into account： （1） establishing incident and shght ~fistake reporting system, with management mechanism and legal support. Pilot experiments should be practiced in high-risk department; （2） developing a training model hke Crew Resources Management（ CRM）, emphasizing non-technical skills training; （3） reinforcing staff and environment management for the control of human-origin risk; （4） constructing database for better information collection and analysis, developing and using perspective analyzing tools; （5） assessing the safety culture of medical organization with the tools used by aviation industry, and taking the experience of aviation safety culture construction.
Objective By reviewing and analyzing the experiences and lessons of American hurricane risk management, this study aims to explore the possible application of constructing the system for medical risk management in China. Methods We searched the EI database (1969 to 2005), OVID database (1966 to 2005), Superstar electronic library and some websites such as Federal Emergency Management Agency (FEMA), National Oceanic and Atmospheric Administration (NOAA), and Centre for Disease Control and Prevention (CDC). The retrieved articles were screened independently by two reviewers according to the inclusion and exclusion criteria. The included articles were classified and the quality was ranked. Results Total of 227 articles and 1 book met the eligibility criteria. The articles related to risk prediction occupy 73.13%. The American hurricane database can be traced back to 1886. Disaster Relief Act was promulgated in 1950, and there were various types of policies for disaster risk management. The FEMA, set up in 1979, played a key role in disaster risk management. The precaution was announced according to the different levels of hurricane risk, and the forecasts were mainly made by NOAA. The American government and some non-governmental organizations were involved in hurricane emergent responses concerning both physical and mental health of the public. In addition, there were many methods to evaluate and predict hurricane risk. The main lessons from hurricane Katrina risk management lay inunderestimation of the risk and political discrimination. Conclusion There are both distinctive advantages and disadvantages in the present status of American hurricane risk management. As the monitoring and precaution system of medical risk management in China are still in an initial stage, we can learn the experience and lessons from American hurricane risk management to construct and run our system of medical risk management better.
Objective To provide evidence for establishing a medical risk precaution and monitoring system in China by evidence-based evaluation of the medical risk monitoring and precaution system in Canada, including the current situation and corresponding prevention measures. Method According to the unified search strategy made by our research group, we searched relevant databases and official or government websites. We included articles about medical risk management, medical error and patient safety in Canada. The included articles were classified and the quality was ranked. Results A total of 15 articles were included, among which 10 were official documents (about 2/3) and 5 described research methods (about 1/3), mainly involving medical risk management or evaluation, medical error and patient safety. In 2002, Canada established its National Steering Committee on Patient Safety (NSCPS) and proposed the suggestions to integrate health care resources accross the country, build a patient safety system, and established the Canada Patient Safety Institution (CPSI) to improve patient safety. Canada revised the patient safety management system, collected and issued related information, strengthened doctor-patient communication, developed continuous education for medical staff, practiced the best medical behavior and model and improved lawsuit procedures. These activities have achieved great progress in practice. Conclusions What have been done in Canada will provide a guide for us to establish scientific patient safety system and promote public awareness of patient safety.
The artificial ventilation system is a multi-factor system with some high uncertain risks which should be under controlled by medical risk management of hospitals. The key suggestions for reducing the accidence caused by ventilator are recommented： 1 ） to clarify the risk factor of ventilators, 2 ） to set up management group of ventilators with a clinical engineer who is good at management and quality control of medical equipment on ventilators, 3 ） to develop ventilator clinical practice for safety use, 4 ） to explore the effective risk monitoring and early warning system and mechanism on ventilator application.
ObjectiveTo provide some basic data for studies in the future on the prevention of medical disputes by exploring its patterns and reasons. MethodsFifty-five processed medical disputes cases accepted between 2012 and 2014 were retrospectively analyzed for their patterns and causes. ResultsThe number of males in the medical disputes was higher than that of females (male: 60.0%, female: 40.0%), and patients at the age of 40-70 also led in the disputes (aged 40-50: 20.0%, aged 50-60: 18.2%; aged 60-70: 20.0%). There were more medical disputes in the department of cardiology (20.0%), orthopedics (16.4%), otolaryngology (12.7%), and gynecology (10.9%). ConclusionThere are differences in gender and age of the patients as well as departments in terms of medical disputes. We should try to discover the regular patterns of these disputes. Besides those existing medical indexes, we should establish other warning systems through psychological and sociological status of medical staff and patients for reducing medical disputes, which can surely help the administration of medical quality intervention on medical disputes.
This article introduced the structure and features of the medical safety and quality management system of New South Wales (NSW) of Australia. The system was funded by government with overall design, multi-sectors involvement, and explicit roles of government, hospitals, and independent third parties. The system also developed national and state-wide regulations, policies, standards and their certification. The NSW Health Incident Information Management System (IIMS), the guidelines and interventional programs were also established to decrease the medical risk and ensure the healthcare quality. This system will be used for reference to the national medical risk and quality management system of China.
Objective To evaluate evidence from American medical risk monitoring and precaution system (AMRMPS) which may affect the construction of Chinese medical risk monitoring and precaution system (CMRMPS). Methods We searched relevant databases and Internet resources to identify literature on AMRMPS, medical errors, and patient safety. We used the quality evaluation system for medical risk management literature to extract and evaluate data. Results In 1999, a report from the Institute of Medicine (IOM) not only showed the severity and cause of medical errors in America but also gave the solution of it. In 2000, the Quality Interagency Coordination Task Force (QuIC) was appointed to assess the IOM report and take specific steps to improve AMRMPS. After 5 years, a well-developed medical risk management system was established with the improvement in the public awareness of medical errors, patient safety, performance criteria of medical safety, information technology and error reporting system. There was still some weakness of this system in risk precaution and prevention. Conclusion The experience from AMRMPS can be used to establish the CMRMPS. Firstly, we should disseminate and strengthen the awareness of medical risk and patient safety in public. Secondly, we should establish hospital audit system which includes auditing of medical staff and course of medical risk in continuing and academic education. Thirdly, we should develop regulations and guidelines on health care, medical purchase and drug supply which will benefit in management of regular work. Fourthly, we should develop computer information system for hospital which will regulate the management without the disturbance from human. Lastly, we should emphasize outcome evaluations and strive for perfection during the process.
ObjectiveTo provide a reference for the implementation of risk management in other medical institutions by introducing the practical experience of building a medical risk management system in West China Hospital of Sichuan University.MethodsBased on Donabedian’s SPO model, the practical experience in the construction of West China Hospital of Sichuan University was summarized from the aspects of structure, process, and results.ResultsThe establishment of medical risk management system made the hospital adverse event management effect good, and the risk management indicators were good. The average number of medical disputes in hospitals from 2016 to 2018 was 103.33, the average number of medical disputes per 100 medical practitioners was 7.01, the average number of medical disputes per 10 000 surgical cases was 6.55, and the average number of medical disputes per 10 000 cases was 0.18.ConclusionThe construction of medical risk management system is conducive to enhancing the awareness of medical risk prevention among medical institutions, continuously improving the quality of medical care and medical safety of hospitals, ensuring patient safety, promoting harmony between doctors and patients, and promoting the realization of healthy China.