縮短醫事糾紛鑑定回復天數之品質改善專案

Quality Improvement Project for Shortening Duration of Appraisal by Medical Experts in Medical Disputes

醫事糾紛鑑定係指當醫療糾紛發生並涉及訴訟時，藉由第三人的鑑定機關，就委託鑑定機關所提出之卷證資料及委託鑑定的事由，依照病歷紀錄提供客觀的醫療專業意見予委託鑑定機關作為認定事實之參考。衛生福利部設有醫事審議委員會，其下並設醫事鑑定小組，並訂有醫療糾紛鑑定作業要點據以辦理醫療糾紛案件之鑑定。101 年度醫學中心任務指標規範，各醫學中心須積極參與衛生及司法機關委託之醫療糾紛鑑定工作，且品質良好，而為掌握醫療糾紛鑑定之回復時效及品質，並訂有相關時效及品質指標，102 年度則進一步規範須成立專責單位，進行相關鑑定工作，並必須有計畫的培訓院內之鑑定專業人才。據統計，醫事鑑定小組每年所受委託鑑定件數，至2011 年已達584 件，仍逐年增加中，醫療糾紛鑑定可協助檢察官及法官判斷醫師是否違反醫療上應注意之義務，在醫療糾紛裁判過程中扮演非常重要的角色，如何有效處理醫事糾紛案件鑑定，以解決醫療糾紛曠日費時之現況，誠屬亟需面對之課題。

In medical disputes and malpractice that led to litigation, an independent party is usually consulted for appraisal and assessment. This independent party is given all documents and the reasons for assessment were informed. By going through medical records, the third party provides objective and expert opinion on the medical dispute, which then becomes part of the reference in the medico-legal process. The Ministry of Health and Welfare has a committee on medical disputes, under which, a panel of experts was set up. Guidelines and rules were established in order to conduct medical disputes appraisal and assessment. In the 2012 recommendation of the hospital accreditation guidelines, all medical centers are encouraged to actively participate in the expert assessment of medical disputes/malpractices that were commissioned. In order to improve the quality and the efficiency of such proceedings, in the 2013 guideline, it was further recommended that hospitals should establish a dedicated unit for the purpose of medical disputes appraisal and assessment. A program should also be set up for the training of such personnel. In 2011, medical disputes that were commissioned for appraisal reached 584 cases, and the number is still rising. Medical disputes assessment plays an increasingly important role in medico-legal proceedings. It can assist prosecutors and judges in determining whether a physician violated the usual medical obligations. Since these processes are usually time consuming, by having an efficient medical disputes expert team in a hospital that is able to provide medical disputes assessment in a timely fashion greatly shortens such process, thus improving quality.