谭丽萍 谭春兴 尹月萍 李晓霞 庄君灿

[摘要] 目的 探讨护理风险管理对急诊科“三无”患者的临床效果。 方法 选取2012年1月～2013年12月急诊科“三无”患者84例作为对照组，给予常规护理，选取2014年1月～2015年11月急诊科“三无”患者103例作为观察组，给予风险管理护理。比较两组患者的去向、联系家属情况，不良事件发生情况、候诊区停留时间、急诊科停留时间等。 结果 观察组联系上家属率高于对照组，自行离院率及拒绝治疗、拖延出院、暴力行为发生率、总不良事件发生率低于对照组（P<0.05）；观察组候诊区停留时间、急诊科停留时间短于对照组（P<0.05）。 结论 对急诊科“三无”急诊患者采取风险管理措施，可有效减少护理风险事件的发生，保护双方权益。

[关键词] “三无”患者；护理风险；护理管理；不良事件

[中图分类号] R192.6 [文献标识码] A [文章编号] 1674-4721（2016）03（b）-0172-04

[Abstract] Objective To explore the clinical effect of nursing risk management for "three-without" patients in department of emergency. Methods 84 "three-without" patients from January 2012 to December 2013 in department of emergency were selected as control group and were given routine nuring.101 "three-without" patients from January 2014 to Novemner 2015 in department of emergency were selected as observation group and were given risk management nuring.The disposition，contacting family situation，incidence of adverse event，time spenting in waiting area and time in department of emergency of patients between two groups was compared respectively. Results The contacting family situation rate in observation group was higher than that of control group，but the rate of departure from the hospital on themselves and incidence rate of refusing to accept the treatment，delaying out of the hospital，violent behavior and total incidence rate of adverse event was lower than that of control group respectively （P<0.05）；time spenting in waiting area and time in department of emergency was shorter than that of control group （P<0.05）. Conclusion Risk management measures conducted for "three-without" patients in department of emergency can reduce effectively the incidence of nursing risk event and protect the rights and interests of both sides.

[Key words] "Three-without" patients；Nursing risk；Nursing management；Adverse event

“三无”患者是指无亲友陪伴、无家庭住址、无经济支付能力的患者，近年来因城市流动人口的增多、人民收入差异扩大，“三无”患者人数明显增加[1-2]。救死扶伤是医院的基本职责，但救治“三无”患者不仅易导致医疗纠纷，还给医院带来巨大的经济压力，特别是危重症患者“先看病，后收费”正常出台后，“三无”患者每年拖欠医疗费用明显增长，最新调查显示，“三无”人员年拖欠费用30～40亿元[3-4]。“三无”患者本身也存在较大的护理风险，护理难度大，处置较为棘手。自2014年以来我院急诊科针对“三无”急诊患者进行了风险评估，并制定了一系列的风险管理措施，取得了一定成效。

1 资料与方法

1.1 一般资料

2012年1月～2013年12月急诊共收治“三无”患者84例，纳入对照组，其中男54例、女30例，年龄11～78岁、平均（55.4±8.5）岁。路人送院32例、110或救护车送院52例。2014年1月～2015年11月急诊收治“三无”患者103例，纳入观察组，其中男68例、女35例，年龄8～84岁、平均（58.3±11.7）岁。……