臺灣博碩士論文加值系統

正確的影像醫學診斷報告是治療癌症患者不可或缺的一步。現代醫療分工日益複雜，錯誤也更容易發生，如何進行系統性的分析，提高癌症影像報告品質，顯得更為重要。醫療照護失效模式與效應分析(HFMEA)是醫療界所使用的一種前瞻性、結構性的系統風險分析工具，可對醫療作業系統做出全面性的探討，協助醫療管理者面對問題時決定處理優先順序，改善相關制度、技術、工具或方法，避免不良事件的發生。

本研究將HFMEA導入中部某區域教學醫院的放射診斷科，按照HFMEA的五個步驟，針對癌症患者所做的電腦斷層與磁振造影檢查之影像報告流程，找出流程內最需要改進的失效模式與原因，擬定對策與改善方案。本研究對於癌症影像報告診斷流程的失效模式與原因，進行歸類後所得到的五個重點與改善對策分別為：
一、臨床資訊面：重點在於促進臨床資訊的流通與分享，解決方案為簡化資訊的取得、檢討與改善異常個案，並與各科醫師建立溝通共識。
二、影像品質面：重點在取得良好的影像品質，解決方案為設定影像檢查標準作業流程、影像品質提升會議、建立影像審查與監督機制，及提升專業人員知識與技術。
三、影像判讀面：傳統影像判讀流程依然具有改善的空間，需要建立一套機制避免或矯正錯誤，改善方案為制定癌症醫學影像報告「複審機制」、「即時回饋機制」、設立「同儕審查會議」，並制定相關的監測指標。
四、影像輸入面：重點在於依據醫院的需求訂定標準，明訂與制式化癌症醫學影像報告必備的重要資訊。解決方案為制定「癌症影像報告標準格式」，標準化輸入過程，提高癌症影像報告的完整性。
五、回饋機制面：重點是針對放射科醫師與臨床醫師設立一套提醒與回饋機制，避免的資訊不對等與可能發生的人為錯誤。解決方案為設立「異常影像報告結果通報機制」，提醒臨床醫師注意影像結果，並制定「影像報告回饋機制」，提供臨床醫師快捷的回饋管道。
本研究顯示以HFMEA改善癌症影像報告診斷流程，可有系統找出流程的潛在問題、建立團體共識、改善制度缺失、減少不良錯誤、增加組織承擔錯誤的能力，達到提升病患安全與醫療服務品質的目的。

The correct imaging diagnosis is the first step to cancer patient treatment. Due to the increasing complexity of contemporary medical workflow, it is important to conduct systematic analysis in order to improve the quality of imaging reports. Healthcare Failure Mode and Effects Analysis (HFMEA) is a prospective and structural risk analysis tool in medical practice, which allows further comprehensive investigation and discussion of current medial operating system. Furthermore, it can also assist medical institute managers to make prioritized decisions on medical problems by improving relevant systems, technology, tools or methods to avoid the occurrence of harmful incidences.
The purpose of this research is to introduce HFMEA into the radiological department in a regional teaching hospital in central Taiwan. By following the five steps of HFMEA, failure modes and causes were identified, which were most crucial in improving the process, developing strategies and improvement programs for cancer imaging reporting process. In this research, the causes of failure modes for the diagnostic process of cancer imaging reporting were categorized into five aspects as following:
1. Clinical information: the focus is to facilitate the flow and sharing of clinical information. The solution aims to simplify information accession, review and improve the handling process of abnormal cases, and establish a communication channel among clinical physicians.
2. Image quality: the focus is to obtain decent image quality. The solution includes setting up a standard imaging examination process, arranging image quality improvement meetings, establishing imaging supervision and assessment mechanisms, and improving skills and knowledge of technicians.
3. Imaging interpretation: Improvements are needed in the traditional imaging interpretation process. Therefore, a mechanism must be established to prevent or correct mistakes. The improving programs are to set up medical imaging report "review mechanism ","real-time feedback mechanism, "peer review meeting", and develop relevant monitoring indicators.
4. Image reporting: the focus is to set up standards according to the needs of the hospital, standardize and specify important information necessary for cancer imaging reports. The solution is to develop "cancer imaging reporting standard format", which can standardize the process of image report and improve the quality of cancer imaging reporting.
5. Feedback mechanisms: the focus is to set up a reminder and feedback mechanism between radiologists and clinicians to prevent information asymmetry between the two which may result in fatal human error. The goals of this mechanism are to establish "abnormal imaging report notification mechanism," to remind physicians paying attention to imaging results, and to develop "Imaging report feedback mechanism" to provide fast feedback channels for clinicians.
This study has shown that using HFMEA to improve the cancer imaging diagnostic process can find potential problems, establish group consensus, reduce harmful mistakes, increase accountability of our department. This method can achieve the purpose of improving patient safety and strengthening service quality of medical.

論文題目 I
謝 誌 I
中 文 摘 要 I
英 文 摘 要 III
目 錄 V
圖目錄 VII
表目錄 VIII
第一章 緒論 1
第一節 研究背景 1
第二節 研究動機 2
第三節 研究目的 4
第四節 研究流程 4
第二章 文獻探討 6
第一節 醫療環境的現況 6
第二節 癌症治療的現況 10
第三節 醫療失效模式與效應分析的歷史 13
第三章 研究步驟 21
第一節 定義HFMEA之主題 22
第二節 組織團隊 22
第三節 繪製流程圖 23
第四節 執行危害分析 23
第五節 行動與結果量測 25
第四章 個案研究 27
第一節 個案背景 27
第二節 HFMEA於個案醫院癌症影像報告改善 28
第三節 運用HFMEA於個案醫院癌症影像報告之分析與成果 48
第五章 結論與建議 67
第一節 結論 67
第二節 建議 69
第三節 研究限制 71
參考文獻 72
一、中文部份 72
二、英文部份 74

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