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.
目的 探讨风险管理在医院感染管理中的应用与效果。 方法 以风险管理知识为指导，通过分析医院感染管理工作中存在或潜在的医院感染风险制订风险管理预防，指导临床规避和化解感染风险，确保医疗安全。 结果 风险管理的实施提高了医院感染管理质量，减少了医院感染的发生。 结论 风险管理在医院感染管理中的应用不仅可以降低医院感染的风险，也提高了医疗质量。Objective To investigate the application of risk management in hospital infection control and its effect. Methods Guided by risk-management knowledge, we analyzed the potential infection risks in hospital infection control work and regulated risk management policies, in order to avoid and defuse the risk of infection and ensure medical safety. Result The implementation of risk management improved the quality of hospital infection control, and reduced the incidence of hospital infections. Conclusion Risk management in hospital infection control can not only reduce the risk of infection, but also improve the quality of care.
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 Interpretation of the growing body of global literature on health care risk is compromised by a lack of common understanding and language. This series of articles aims to comprehensively compare laws and regulations, institutional management, and administration of incidence reporting systems on medical risk management in the United Kingdom, the United States, Canada, Australia, and Taiwan, so as to provide evidence and recommendations for health care risk management policy in China. Methods?We searched the official websites of the healthcare risk management agencies of the four countries and one district for laws, regulatory documents, research reports, reviews and evaluation forms concerned with healthcare risk management and assessment. Descriptive comparative analysis was performed on relevant documents. Results?A total of 146 documents were included in this study, including 2 laws (1.4%), 17 policy documents (11.6%), 41 guidance documents (28.1%), 37 reviews (25.3%), and 49 documents giving general information (33.6%). The United States government implemented one law and one rule of patient safety management, while the United Kingdom and Australia each issued professional guidances on patient safety improvement. The four countries implemented patient safety management policy on four different levels: national, state/province/district, hospital, and non-governmental organization. Conclusion?The four countries and one district adopted four levels of patient safety management, and the administration modes can be divided into an “NGO-led mode” represented by the United States and Canada and a “government-led mode” represented by the United Kingdom, Australia, and Taiwan.
Objective To comprehensively compare the methods and tools for medical risk management and assessment in the United Kingdom, the United States, Canada, Australia and Taiwan region (hereafter shortened as “four countries and one region”), so as to provide evidence and recommendations for medical risk management policy in China. Methods The official websites of the healthcare risk management agencies in these four countries and one region were searched to collect materials concerning healthcare risk management and monitoring, such as laws, regulatory documents, research reports, reviews and evaluation forms, then the descriptive comparative analysis was performed on the methods and tools for risk management. Results a) A total of 146 documents were included in this study, including 2 laws, 17 regulatory documents, 41 guidelines, 37 reviews and 49 documents about general information; b) The United Kingdom applied the integrated risk management; Australia and Taiwan adopted the classical risk management process, including risk identification, risk analysis, risk evaluation and risk control, while the United States and Canada mainly chose the prospective failure mode and effects analysis (FMEA) for clinical risk management; c) The severity of clinical risk was divided into five grades in the United Kingdom and Australia, and six in Taiwan, respectively. The frequency of medical risk was divided into five grades with four grade responses in above two countries and one region; and d) There were almost the same processes and tools about Root Cause Analysis (RCA), but a little difference in the objects of analysis in these four countries and one region. Conclusion?There are three models of risk management with the same assessment tools in these four countries and one region: the prospective risk assessment, the retrospective assessment based on occurred incidents and the integrated risk management. Although the grading of risk is similar, the definition of grading is different in the United Kingdom, Australia and Taiwan. The methods and processes of analyses on the adverse events are almost the same in these four countries and one region.
Objective To analyze the policy and guideline, the institutional management and the operation mechanism of ICU medical risk management in the United Kingdom, the United States, Australia, Canada and Taiwan, so as to provide evidence and recommendations for health care risk management policy in China. Methods Such databases as PubMed, EMBASE, The Cochrane Library were searched to include the literatures such as the guideline documents and the research reports on ICU medical risk management in the United Kingdom, the United States, Australia, Canada and Taiwan; the institutional management and the operation mechanism of the risk management in the above four countries and one area were comprehensively analyzed, and especially the UK model was highly emphasized. Results A total of 31 literatures were included, including 1 guideline, 5 reviews, 2 investigative reports and 23 research documents. The United Kingdom guided the ICU risk management in forms of the standard and the guideline, formulated a clear tool of event classification and corresponding response mechanism. The United States learned from Australia’s experience and established the ICU safety reporting system; both of them regarded ICU as one part of the medical risk management and set up a special management column. Conclusion The ICU risk management with the independent report system in the United Kingdom is brought into the scope of national patient safety management, and is regarded as the relative complete system at present. In Australia and the USA, the national institutions are in charge of setting up the research projects of ICU risk management; the industry associations and the non-governmental organizations lead the risk research; and the experimental units popularize gradually after self-application.