The Physician’s Knowledge, Attitude and Responses toward Patient Safety Issues --- Case Studies from Hospitals in Northern Taiwan

• Main Authors: Bih-Jeng Chang, 張必正
• Other Authors: Kuo-Piao Chung
• Format: Others
• Language: zh-TW
• Published: 2003
• Online Access: http://ndltd.ncl.edu.tw/handle/85925102471891517493

碩士 === 國立臺灣大學 === 醫療機構管理研究所 === 91 === Abstract The purpose of this study includes: First, to understand physicians’ experiences on medical errors as well as the types of errors, causes of errors, and the outcomes of errors in hospitals of Northern Taiwan. Second, to understand physicians’ knowledge and attitude on patient safety. Third, to understand physicians’ responses related to medical errors. And finally, to explore the factors which influence physicians’ responses to medical errors. This is a cross-sectional study. A structural questionnaire was mailed and replied by both residents and attending physicians in six hospitals of Northern Taiwan to evaluate their experiences on medical errors in year 2002, to understand types of errors, causes of errors, outcomes of errors, and their knowledge, attitude, and responses toward errors as well. Two hundred and ten valid questionnaires were obtained with the response rate of 28.89%. Major results of this study were listed below: Physicians’ experiences on medical errors There were 30.6% of physicians that experienced medical errors in year 2002. More male (46.7%) than female patients (26.3%) suffered from errors and most of them are elderly (43.1%). There were 59% of patients that encountered medical errors during their admission and most of them had mild systemic disease at first visit. Physicians are prone to errors when they are younger or junior in their practicing experience. Types, causes and outcomes of medical errors The most frequently reported type of error was an error in assessment (25.4%). The most frequent cause of error was inexperience (25.4%). Male physicians were prone to misdiagnosis. Older physicians easily had medical errors due to poor communication with patients. Seventy percent of errors resulted in adverse effects and most of them with prolonged admission and more medical procedures or treatments. From study results, approximately, 17.46% of medical errors led to patients’ death. Knowledge and attitude on patient safety Five factors of physicians’ attitude on patient safety were subtracted from factor analysis and were named as factors of “Education and strategy”, “Causes and responses to errors”, “Report and management”, “Patient and doctor’s treatment”, and “Team work and communication”. Physicians’ religious belief was related to their attitude on such issues. Responses to medical errors Four factors of physicians’ responses to medical errors were subtracted from factor analysis and were named as factors of “Vigilance and knowledge”, “Avoidance and hiding”, “Communication and discussion”, and “Low mood”. Factors that influenced physicians’ responses to medical errors were: 1. Factors of “Education and strategy”, “Causes and responses to errors”, and “Team work and communication” had positive effects on the factor of “Vigilance and knowledge-pursuing”, while medical errors leading to patients’ death and the factor of “Patient and doctor’s treatment” had negative effects. 2. Physicians’ age, treatment and medication errors, errors in nursing staffs, errors in explanation, errors in executive management, and the factor of “Education and strategy” had positive effects on the factor of “Avoidance and hiding”, while patients’ poor health condition, medical errors due to faulty communication with the patient, and the factor of “Patient and doctor’s treatment” had negative effect. 3. Religion of Buddhism and the factor of “Causes and responses to errors” had positive effects on the factor of “Communication and discussion”, while errors in medical procedure or technique and medical errors leading to patients’ death had negative effects. 4. The factor of “Patient and doctor’s treatment” had positive effect on the factor of “Low mood”. Three suggestions were made according to research findings. First, the health authorities should put patient safety related materials into medical education. Annual goals should be made to prevent the most frequent diagnostic and medication errors. Second, hospital managers should be less critical on medical errors, and develop a non-punishable environment to ensue free communications over this issue. Conferences of medical errors should be held periodically to look for latent failures in the system. Continuous medical education on safety concepts should be conveyed to house staffs. Finally, future research could include method of chart review, qualitative research, and data analysis of adverse events on medical errors, to construct a broader content of this topic.