| Summary: | 碩士 === 國立臺灣大學 === 衛生政策與管理研究所 === 89 === Abstract
The Institute of Medicine’s (IOM) publication of To Err is Human at the end of 1999 brought medical errors the attention it has never had. While the evidence of medical errors has been reported in the literature published in as early as the 1960s, IOM’s report succeeded in capturing the public’s attention by revealing the magnitude and pervasion of this problem. Briefly speaking, medical errors are those made by related participators in medical behaviors. Medical errors may further result in medical injury. The problems among them are the loss of quality and cost in medicine. At present, studies in Taiwan still focused on the downstream of this problem─ malpractice, and lacked the understanding of medical injury and medical errors. Because of the difficulties in making sense of and conducting study on these concepts, Taiwan lacks for systematic researches in this field. Consequently, malpractice is still occurring and increasing.
This study takes the comparative method, using empirical evidences mainly from U.S.A. accompanied with those from Australia and England to know the methodology adopted in studying this concept in developed countries. The study is intended to explore methods that could be used in Taiwan in the future.
From evidences of American researches, there are two methods used widely─ incident reporting system and chart review method. The review of medical records needs great input in the staff, money and duration. As a result, the method has its own limitation but is the most rigorous one. The validity of incident reporting system is not so good as that of chart review method, particularly in the case of voluntary reporting. Moreover, it might hinder physicians from reporting especially if there is no open and liberal condition to ensure that reporters will not be punished for their errors. As the reporters in the incident reporting system, physicians are nonetheless a perfect group for intervention to reduce error rate.
Nowadays, there is study using neither chart review method nor incident reporting method in Taiwan. There are only studies by filling out questionnaires. One UK study used two American studies as the base to estimate the number of patients injured by medical management in the country. Though without adjusting, it still provided us with a rough image. Based on the method used in the UK study and related statistics from American ones, the number of Taiwanese inpatients killed by preventable medical injury is estimated to be around 3,000 every year even by the more conservative figure, which precedes that of the ninth leading cause of death in Taiwan. Therefore, we should be aware of the acute problem from this rough idea.
In terms of methodology, the suggestion of this thesis is as follows: In the short run, it is considerable to develop incident reporting systems inside hospitals. The cost won’t be too high but the method still has its efficacy. In the middle stage, it is important to adopt chart review method in addition at hospitals to know medical errors well. In the long term, only with the public awaken and enough resources and support can we conduct studies using chart review method suit for Taiwan to figure out a clear image of medical injury and medical errors in our own country. Before that, it should be ready in many aspects such as charts, physicians’ participation, an interdisciplinary study team, and a leader ingenious in this field. As the chart review method is very expensive, computerized event monitoring or incident reporting is suggested to be a cost-effective method for regular and routine use.
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