美国、英国、加拿大和澳大利亚产科风险管理分析

摘要

Objectives: We conducted a review of risk management in obstetric department articles to retrieve basic institution setting information and administration mode and to provide evidence for the research and development as well as the risk management of China Methods: Laws and regulations, research reports and reviews on risk management in obstetric department were electronically searched and identified from PubMed, EMBASE, The Cochrane Library and their official websites. Results: We finally included 39 studies. There were 27 articles related to Risk Management in Obstetries Department of America, 6 articles related to Britain, 3 articles related to Canada, and there was only one paper reporting Australia. The British Cillege of Obstetricians and Gynaecologists was founded earlier than other three countries, whose members nearly half were based outside the UK. Guidelines or documents were published by the college of Obstetricians and Gynaecologists of America, Britain and Canada for helping the physicians to manage the risk. ACOG specially established the obstetric safety reporting system to improve the patient safety and launched the VRQC. The Care Bundles Project was overseen by the steering group in the UK. SOGC also initiated the project named "MORE OB". Conclusions: Administrative organzations for risk management of obsteric were established in above four countries.It is very urgent to establish and improve the obstetric safety reporting system and to publish the guidelines for managing the risk in obstetrics department of China. The international exchanges and cooperation should be enhanced in order to improve the sevice quality and reduce the obstetrician risk.%目的:通过检索美国、英国、加拿大和澳大利亚产科风险管理相关的法律法规、研究报告和综述等,分析其产科风险管理的机构设置和管理模式等,为国内的产科风险管理提供参考依据.方法:电子检索四国官方网站及Pubmed、Embase和Cochrane Libray,搜集产科风险管理相关的法律法规、研究报告和综述等,进行分析整理.结果:最终纳入39篇文献,其中美国27篇、英国9篇、加拿大3篇、澳大利亚1篇.四国均设有符合本国特色的妇产科医师学会,以英国皇家学会历史悠久,且境外会员居一半;除澳大利亚外,美、英、加均发布指南或文件指导解决本国的产科风险问题;美、加两国启动有关产科病人安全的项目,且相互交流学习;英国针对分娩护理设立专项项目;美国专门建立产科安全报告系统,用以改善病人安全.结论:美、英、加、澳四国均建立了各自的产科风险管理机构和程序.建议建立和完善国内产科事件报告系统和产科风险管理指南以指导产科风险报告与管理,并加强与国内外交流合作,以提高服务质量,降低产科风险.