醫院層級在病人安全事件通報態度、知識之差異

Differences in Patient Safety Reporting Attitudes and Knowledge Among Different Hospital Levels

背景：建立醫療正向通報文化，從錯誤中學習，進而預防未來異常事件發生，是病人安全文化塑造之重要基礎建設。目的：藉由問卷調查瞭解各層級醫院病人安全通報知識與態度的差異，找出影響因素。方法：本研究採橫斷式問卷調查，共收案6家醫院，含2家醫學中心、2家區域醫院、2家地區醫院，對象包括醫師、護理、醫技行政人員等，填寫「病人安全通報調查問卷表」。結果：本研究受試者共348名，有效問卷數為348份，回收率為100％。病人安全通報知識總分為14分，受訪者平均分數為12.76分，在年齡、職務級別及年資與通報知識達統計上顯著差異（p＜.01）。病人安全通報態度共21題，採李克特量表（Likert）五分法計分，平均分數為3.92±0.50，在性別、年齡、職務級別、年資及職稱類別與通報態度達統計上顯著差異（p<.01）。醫院層級間通報知識與通報態度，僅於通報態度有統計上顯著差異（p＝.01），以「醫學中心」表現最佳。受訪者年齡越大及職務級別越高者，不論是在病人安全通報知識或態度上得分均越高。結論：建置優良的病人安全事件通報文化成功的關鍵在於醫療團隊人員對通報系統感到安全、信任與操作簡易方便。相較於知識可以透過教育訓練、宣導傳達人員，通報態度需要花費較多資源與時間，區域醫院可考慮投入更多資源，提升正向通報態度，進而增加人員通報意願。

Background: Establishing a positive reporting culture, which helps medical and healthcare workers learn from errors and reduce the risks of future adverse events, is essential to fostering a culture of patient safety. Purposes: The objectives of this study were to investigate the differences among the three levels of hospitals in terms of the knowledge and attitudes of hospital staff regarding the patient safety reporting system and to identify the potential factors affecting these differences. Methods: This cross-sectional study was carried out in six hospitals, including two academic medical centers, two regional hospitals, and two district hospitals. The subjects were physicians, nurses, medical technicians, and administrative staffs. Data were collected using a patient safety reporting questionnaire. Results: Three hundred and forty-eight participants were recruited, with 348 valid questionnaires returned (response rate: 100%). The average score for knowledge of patient safety reporting was 12.76 (total possible score: 14). Age, work position, and work experience were significantly associated with knowledge of patient safety reporting (p < .01). The patient safety reporting attitudes questionnaire comprised 21 items, each of which was scored using a five-point Likert scale. The mean score for each item was 3.92 ± 0.50. Gender, age, work position, work experience, and job discipline were significantly associated with attitude toward reporting (p < .01). The level of hospital was found to significantly impact attitudes toward patient safety reporting (p = .01), with participants working at medical centers scoring the highest. In addition, participants who were older and in more-senior positions scored higher and more positively for both knowledge and attitudes. Conclusions: The key factors to successfully fostering a strong patient safety reporting culture are staff security, a reliable reporting system, and a user-friendly interface. Improving attitudes toward reporting requires more resources and time than improving knowledge of reporting, which may be improved using education and promotion. Regional hospitals may invest more resources to enhance positive attitudes toward reporting and increase the willingness of staff to report.