臺灣地區住院醫療疏失案件流行病學分析：以2007年為例

Epidemiology of in-hospital Injuries in Taiwan in 2007

鍾其祥(Chi-Hsiang Chung) ； 高森永(Sen-Yeong Kao) ； 白璐(Lu Pai) ； 簡戊鑑(Wu-Chien Chien)

《醫務管理期刊》 11卷3期 (2010/09) Pp. 59-74

https://doi.org/10.6174/JHM2010.11(3).59

摘要

目的：分析住院醫療傷害案件流行病學特性，包括類型、性別、年齡、醫院層級、就醫科別與住院預後。
方法：串連2007年全民健保「住院醫療費用清單明細檔(DD)」、「醫事機構基本資料檔(HOSB)」與「醫事人員基本資料檔(PER)」進行分析，並根據ICD-9-CM將傷害事件分成「切穿割刺(998.2，E870)」、「異物遺留(998.4，998.7，E871)」、「無菌失當(E872)」、「劑量失當(E873)」、「儀器故障(E874)」、「污染物質(E875)」、「不當輸液(999.6，999.7，E876)」七類，統計分析採用SPSS 18.0。
結果：2007年住院醫療傷害有1,113件（發生率為每10萬接受手術處置住院傷患有57.98人）。女性(52.74%)比男性(47.26%)多，年齡層以70-74歲最多(10.69%)。「切穿割刺」為主要的類型(78.80%)，病患多在醫學中心就診(58.76%)，就醫科別主要為婦產科(20.31%)。在這些案例中，有2.52%病患預後狀況為病危自動出院、2.07%為死亡，預後較差的病患過半(56.86%)發生在醫學中心。
結論：臺灣地區住院醫療傷害案件發生率為每10萬接受手術處置住院傷患有57.98人，此數字應低估實際情況，但仍提供了住院醫療傷害案件的全國性實證資料供參考，有助於擬定全面性的病人安全計畫。

關鍵字

醫療傷害案件 ； 全民健保資料庫

並列摘要

Objectives: The aim of this study was to analyze the epidemiology of in-hospital injuries including cause, gender, age, hospital level, department, and prognosis.
Methods: Data from ”inpatient expenditures by admissions (DD)”, ”registry for contracted medical facilities (HOSB)”, and ”registry for medical personnel (PER)” were linked from the national health insurance research database for 2007 by using SPSS 18.0 software. ”Medical injuries” included ”accidental cut, puncture, perforation or hemorrhage (998.2, E870)”, ”foreign object left in body (998.4, 998.7, E871)”, ”failure of sterile precautions (E872)”, ”failure in dosage (E873)”, ”mechanical failure of instrument or apparatus (E874)”, ”contaminated or infected blood or other fluid, drug or biological substance (E875)”, and ”mismatched blood, fluid, or substance in transfusion (999.6, 999.7, E876)” using ICD-9-CM classifications.
Results: There were 1,113 in-hospital injuries (57.98 per 105 inpatients requiring an operation or treatment) in Taiwan in 2007. There were more injuries in females than in males (females: 52.74%, males: 47.26%), and most of them occurred in the 70-74 age group (10.69%). The leading cause of injury was ”accidental cut, puncture, perforation or hemorrhage” (78.80%). Most occurred in medical centers (58.76%), and departments of obstetrics and gynecology had the greatest number (20.31%).
Of those cases, 2.52% were discharged against medical advice, 2.07% died, and more than half (56.86%) bad prognosis cases occurred in the medical center.
Conclusions: The rate of in-hospital injury was 57.98 per 10^5 patients requiring an operation or treatment, and had been seriously underestimated; however, this research provided evidenced-based data for authorities to implement intervention programs to promote patient safety.

並列關鍵字

in-hospital injury ； national health insurance database

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