• 1. 四川大學(xué)華西醫(yī)院循證醫(yī)學(xué)與臨床流行病學(xué)中心, 成都 610041　2. 四川大學(xué)華西醫(yī)院醫(yī)院質(zhì)量管理處, 成都 610041　3. 中國衛(wèi)生部醫(yī)政司, 北京 1000444. 中國醫(yī)師協(xié)會, 北京 100711;

目的　 循證評價國外航空風(fēng)險管理的經(jīng)驗(yàn)及其對醫(yī)療行業(yè)的借鑒意義.　
方法 　計算機(jī)檢索SCO-PUS(1969～2006)等相關(guān)數(shù)據(jù)庫及網(wǎng)站,輔以手工檢索,全面收集有關(guān)航空風(fēng)險及其管理的歷史沿革、經(jīng)驗(yàn)、模型及航空風(fēng)險與醫(yī)療風(fēng)險關(guān)系的文獻(xiàn).
結(jié)果 　與醫(yī)療同為高技術(shù),高風(fēng)險,高專業(yè)性行業(yè)的航空業(yè)現(xiàn)已形成從信息收集到分析、處理的一整套風(fēng)險管理體系,在實(shí)踐中形成了獨(dú)具特色的信息報告系統(tǒng)、提供了各種切實(shí)可行的風(fēng)險分析工具和模型,尤其強(qiáng)調(diào)系統(tǒng)層面建設(shè).
結(jié)論 　我國醫(yī)療行業(yè)可以結(jié)合自身特點(diǎn):①借鑒航空業(yè)的成功經(jīng)驗(yàn),建立針對事件和小差錯的報告系統(tǒng),但必須構(gòu)建與其相適宜的管理機(jī)制和法律環(huán)境,并可選擇高風(fēng)險科室與部門進(jìn)行試點(diǎn).②借鑒航空業(yè)團(tuán)隊(duì)資源管理(CRM)的教程和模式,注重非技術(shù)技能的訓(xùn)l練.③針對人為因素的作用,加強(qiáng)醫(yī)護(hù)人員外部環(huán)境的建設(shè).④建立風(fēng)險數(shù)據(jù)庫,科學(xué)總結(jié)和分析,更好地使用前瞻性風(fēng)險分析工具.⑤各醫(yī)療單位可以先借鑒航空業(yè)成熟的安全文化評估工具進(jìn)行自評,找出差距后學(xué)習(xí)航空業(yè)構(gòu)建安全文化的種種措施.

引用本文： 謝 瑜,文 進(jìn),高曉鳳,孫 丁,李幼平,梁瀟瀟,詹小青,楊天桂,王 羽,張宗久,趙明綱,陸 君,柳琪林. 國外航空風(fēng)險管理方法及績效的循證評價--醫(yī)療風(fēng)險系列研究之一. 中國循證醫(yī)學(xué)雜志, 2006, 06(2): 131-138. doi: 復(fù)制

1. http://www.boeing.com/news/techissues/pdf/statsum.pdf.
2. Institute of Medicine,To err is human:building a safer health system Washington DC:National Academy Press; 2000.
3. Reason J.Human error:model and management.BMJ,2000;320:768-770.
4. ICAO,Annex 13.International Standards and Recommended Practices for Aircraft Accident and Incident Investigation.8th Edition,July 1994.
5. Janic.M.An assessment of risk and safety in civil aviation.Journal of Air Transport Management,2005; 6 (1):43-50.
6. Normra K.Managing risks in airline industry.Japan and the WorldEconomy,2003; 15:469-479.
7. Barach P,Small SD.Reporting and preventing medical mishaps:les sons from non-medical near miss reporting systems.BM J,2000;320:759-763.
8. ODEGARD S.Safety management in civil aviation a useful method for improved safety in medical care? Safety Science Monitor,2000; 4(1):1-12.
9. US Federal Aviation Authority,US FAR 91.25.Aviation Safety Reporting Program:Prohibition against use of reports for enforcement purposes; 1985.
10. McIntyre GR.The application of system safety engineering and management techniques at the US Federal Aviation Administration (FAA) Safety Science,2002; 40 (1-4):325-335.
11. Stoop JA.Accident investigations:Trends,paradoxes and opportuni ties.International Journal of Emergency Management,2003; 1 (2):170-182.
12. Johnson CW.How will we get the data and what will we do with it then? Issues in the reporting of adverse healthcare events,Qual.Saf.Health Care,2003; 12; 64-67.
13. Staender S.Incident reporting systems in medicine.Zeitschrifi furArztliche Fortbildung und Qualitatssicherung,2001; 95 (7):479-484.
14. Stoop JA.Independent accident investigation:A modem safety tool.Journal of Hazardous Materials,2004; 111 (1-3):39-44.
15. Lu AYL.Analysis of aviation occurrence using aviation safety community risk management model approach.Transactions of the Aeronautical and Astronautical Society of the Republic of China,2004; 36 (4):375 -382.
16. Majumda A,Ochieng WY,Nalder P.Trend analysis of controllercaused airspace incidents in New Zealand,1994-2002.Transportation Research Record,2004; (1888):22 -33.
17. Guohua L.Sunsan P,Yandong Q.Driving-while-intoxicated history as a risk marker for general aviation pilots.Accident Analysis and Prevention,2005; 37 (1):179-184.
18. McFadden KL.Risk models for analyzing pilot-error at US airlines:A comparative safety study.Computers and Industrial Engineering,2003; 44(4):581 -593.
19. Allen HW,Abate ML Work process analysis:a necessary step in the development of decision support systems.An aviation safety case study.Interacting with Computers,1999; 11 (6):623-643.
20. Edkins GD.The INDICATE safety program:Evaluation of a meth od to proactively improve airline safety performance.Safety Science,1998; 30(3) 275-295.
21. McFadden KL.Predicting pilot-error incidents of US airline pilots using logistic regression.Applied Ergonomics,1997; 28 (3):209 212.
22. Wreathall J,Nemeth C.Assessing risk:the role of probabilistic riskassessment(PRA) in patient safety improvement.Qual.Saf.Health Care,2004; 13:206-212.
23. Barnett A.Air safety:End of the golden age? Journal of the Opera tional Research Society,2001; 52(8):849 -854.
24. Sachon M,Pate-Cornell E.Delays and safety in airline maintenance.Reliability Engineering and System Safety,2000; 67 (3):301-309.
25. Hunter DR.Measurement of hazardous attitudes among pilots.International Journal of Aviation Psychology,2005; 15 (1):23-43.
26. Conway GA,Mode NA,Berman MD.Flight safety in Alaska:Comparing attitudes and practices of high-and low-risk air carriers.Aviation Space and Environmental Medicine,2005; 76 (1):52-57.
27. Thomson ME..Aviation risk perception:A comparison between experts and novices.Risk Analysis,2004; 24 (6):1585-1595.
28. Thomas MJW.Predictors of threat and error management:Identification of core nontechnical skills and implications for training systems design.International Journal of Aviation Psychology,2004; 14 (2):207-231.
29. Li G,Baker SP,Oing Y.Age,flight experience,and risk of crash involvement in a cohort of professional pilots.American Journal of Epidemiology,2003; 157 (10):874-880.
30. Sicard B,Taillemite JP,Jouve E.Risk propensity in commercial and military pilots.Aviation Space and Environmental Medicine,2003; 74(8):879 -881.
31. Goode JH.Are pilots at risk of accidents due to fatigue? Journal of Safety Research,2003 ;34 (3):309-313.
32. Wenner CA,Drury CG.Analyzing human error in aircraft ground damage incidents.International Journal of Industrial Ergonomics,2000; 26 (2):177 -199.
33. Daniel J.Crew resource management training-clinicians’ reactions and attitudes.AORN Journal,2005; 82(2):213-226.
34. Latorella KA,Prabhu PV.A review of human error in aviation maintenance and inspection.International Journal of Industrial Ergonomics,2000; 26:133-161.
35. Besco R O.Human performance breakdowns are rarely accidents:they are usually very poor choices with disastrous results.Journal of Hazardous Materials,2004; 115:155-161.
36. Krulak DC.Human Factors in Maintenance:Impact on Aircraft Mis hap Frequency and Severity.Aviation Space and Environmental Medicine,2004; 75 (5):429-432.
37. Bove T,AndersEn HB.The effect of an advisory system on pilots’go/no-go decision during take-off.Reliability Engineering and System Safety,2002; 75(2):179 -191.
38. Wiegmann DA,Zhang H,Vonthaden TL.Safety culture:An integrative review.International Journal of Aviation Psychology,2004; 14(2):117 -134.
39. Hudson P.Applying the lessons of high risk industries to health care.Qual.Saf.Health Care,2003;12:7 -12.
40. Geller ES,Hickman JS,Pettinger CB.The Airline Lifesaver:A 17years analysis of a technique to prompt the delivery of a safety message.Journal of Safety Research,2004; 35:357-366.
41. Wang Y.Establishing medical risk monitoring and early warning system for quality improvement and patient safety.Chinese Journal of Evidence-Bused Medicine,2006; 6 (1):1-2.王羽.建立醫(yī)療風(fēng)險監(jiān)測預(yù)警體系,提高醫(yī)療質(zhì)量,保障病人安全中國循證醫(yī)學(xué)雜志,2006;6(1):1～2.
42. Cohen MR.Why error reporting systems should be voluntary.BMJ,2000; 320:728-729.
43. Leape LL.Reporting of Adverse Events.N Engl Med,347 (20):1633-1638.
44. Marx DA,Slonim AD.Assessing patient safety risk before the injury occurs:an introduction of sociotechnical probabilistic risk modeling in health care Qual.Saf.Health Care,2003; 12:33 -38.
45. Leonard M,Graham S,Bonacum D.The human factor:the critical importance of effective teamwork and communication in providing safe care.Qual.Saf.Health Care,2004; 13:85 -90.
46. Thomas EJ,Sherwood GD,Helmreich RL.Lessons from aviation:teamwork to improve patient safety.Nursing Economics,2003; 21 (5):241 -244.
47. Pape TM.Applying airline safety practices to medication administration.Medsurg Nursing,2003; 12(2):77-95.
  1. 1. http://www.boeing.com/news/techissues/pdf/statsum.pdf.
  2. 2. Institute of Medicine,To err is human:building a safer health system Washington DC:National Academy Press; 2000.
  3. 3. Reason J.Human error:model and management.BMJ,2000;320:768-770.
  4. 4. ICAO,Annex 13.International Standards and Recommended Practices for Aircraft Accident and Incident Investigation.8th Edition,July 1994.
  5. 5. Janic.M.An assessment of risk and safety in civil aviation.Journal of Air Transport Management,2005; 6 (1):43-50.
  6. 6. Normra K.Managing risks in airline industry.Japan and the WorldEconomy,2003; 15:469-479.
  7. 7. Barach P,Small SD.Reporting and preventing medical mishaps:les sons from non-medical near miss reporting systems.BM J,2000;320:759-763.
  8. 8. ODEGARD S.Safety management in civil aviation a useful method for improved safety in medical care? Safety Science Monitor,2000; 4(1):1-12.
  9. 9. US Federal Aviation Authority,US FAR 91.25.Aviation Safety Reporting Program:Prohibition against use of reports for enforcement purposes; 1985.
  10. 10. McIntyre GR.The application of system safety engineering and management techniques at the US Federal Aviation Administration (FAA) Safety Science,2002; 40 (1-4):325-335.
  11. 11. Stoop JA.Accident investigations:Trends,paradoxes and opportuni ties.International Journal of Emergency Management,2003; 1 (2):170-182.
  12. 12. Johnson CW.How will we get the data and what will we do with it then? Issues in the reporting of adverse healthcare events,Qual.Saf.Health Care,2003; 12; 64-67.
  13. 13. Staender S.Incident reporting systems in medicine.Zeitschrifi furArztliche Fortbildung und Qualitatssicherung,2001; 95 (7):479-484.
  14. 14. Stoop JA.Independent accident investigation:A modem safety tool.Journal of Hazardous Materials,2004; 111 (1-3):39-44.
  15. 15. Lu AYL.Analysis of aviation occurrence using aviation safety community risk management model approach.Transactions of the Aeronautical and Astronautical Society of the Republic of China,2004; 36 (4):375 -382.
  16. 16. Majumda A,Ochieng WY,Nalder P.Trend analysis of controllercaused airspace incidents in New Zealand,1994-2002.Transportation Research Record,2004; (1888):22 -33.
  17. 17. Guohua L.Sunsan P,Yandong Q.Driving-while-intoxicated history as a risk marker for general aviation pilots.Accident Analysis and Prevention,2005; 37 (1):179-184.
  18. 18. McFadden KL.Risk models for analyzing pilot-error at US airlines:A comparative safety study.Computers and Industrial Engineering,2003; 44(4):581 -593.
  19. 19. Allen HW,Abate ML Work process analysis:a necessary step in the development of decision support systems.An aviation safety case study.Interacting with Computers,1999; 11 (6):623-643.
  20. 20. Edkins GD.The INDICATE safety program:Evaluation of a meth od to proactively improve airline safety performance.Safety Science,1998; 30(3) 275-295.
  21. 21. McFadden KL.Predicting pilot-error incidents of US airline pilots using logistic regression.Applied Ergonomics,1997; 28 (3):209 212.
  22. 22. Wreathall J,Nemeth C.Assessing risk:the role of probabilistic riskassessment(PRA) in patient safety improvement.Qual.Saf.Health Care,2004; 13:206-212.
  23. 23. Barnett A.Air safety:End of the golden age? Journal of the Opera tional Research Society,2001; 52(8):849 -854.
  24. 24. Sachon M,Pate-Cornell E.Delays and safety in airline maintenance.Reliability Engineering and System Safety,2000; 67 (3):301-309.
  25. 25. Hunter DR.Measurement of hazardous attitudes among pilots.International Journal of Aviation Psychology,2005; 15 (1):23-43.
  26. 26. Conway GA,Mode NA,Berman MD.Flight safety in Alaska:Comparing attitudes and practices of high-and low-risk air carriers.Aviation Space and Environmental Medicine,2005; 76 (1):52-57.
  27. 27. Thomson ME..Aviation risk perception:A comparison between experts and novices.Risk Analysis,2004; 24 (6):1585-1595.
  28. 28. Thomas MJW.Predictors of threat and error management:Identification of core nontechnical skills and implications for training systems design.International Journal of Aviation Psychology,2004; 14 (2):207-231.
  29. 29. Li G,Baker SP,Oing Y.Age,flight experience,and risk of crash involvement in a cohort of professional pilots.American Journal of Epidemiology,2003; 157 (10):874-880.
  30. 30. Sicard B,Taillemite JP,Jouve E.Risk propensity in commercial and military pilots.Aviation Space and Environmental Medicine,2003; 74(8):879 -881.
  31. 31. Goode JH.Are pilots at risk of accidents due to fatigue? Journal of Safety Research,2003 ;34 (3):309-313.
  32. 32. Wenner CA,Drury CG.Analyzing human error in aircraft ground damage incidents.International Journal of Industrial Ergonomics,2000; 26 (2):177 -199.
  33. 33. Daniel J.Crew resource management training-clinicians’ reactions and attitudes.AORN Journal,2005; 82(2):213-226.
  34. 34. Latorella KA,Prabhu PV.A review of human error in aviation maintenance and inspection.International Journal of Industrial Ergonomics,2000; 26:133-161.
  35. 35. Besco R O.Human performance breakdowns are rarely accidents:they are usually very poor choices with disastrous results.Journal of Hazardous Materials,2004; 115:155-161.
  36. 36. Krulak DC.Human Factors in Maintenance:Impact on Aircraft Mis hap Frequency and Severity.Aviation Space and Environmental Medicine,2004; 75 (5):429-432.
  37. 37. Bove T,AndersEn HB.The effect of an advisory system on pilots’go/no-go decision during take-off.Reliability Engineering and System Safety,2002; 75(2):179 -191.
  38. 38. Wiegmann DA,Zhang H,Vonthaden TL.Safety culture:An integrative review.International Journal of Aviation Psychology,2004; 14(2):117 -134.
  39. 39. Hudson P.Applying the lessons of high risk industries to health care.Qual.Saf.Health Care,2003;12:7 -12.
  40. 40. Geller ES,Hickman JS,Pettinger CB.The Airline Lifesaver:A 17years analysis of a technique to prompt the delivery of a safety message.Journal of Safety Research,2004; 35:357-366.
  41. 41. Wang Y.Establishing medical risk monitoring and early warning system for quality improvement and patient safety.Chinese Journal of Evidence-Bused Medicine,2006; 6 (1):1-2.王羽.建立醫(yī)療風(fēng)險監(jiān)測預(yù)警體系,提高醫(yī)療質(zhì)量,保障病人安全中國循證醫(yī)學(xué)雜志,2006;6(1):1～2.
  42. 42. Cohen MR.Why error reporting systems should be voluntary.BMJ,2000; 320:728-729.
  43. 43. Leape LL.Reporting of Adverse Events.N Engl Med,347 (20):1633-1638.
  44. 44. Marx DA,Slonim AD.Assessing patient safety risk before the injury occurs:an introduction of sociotechnical probabilistic risk modeling in health care Qual.Saf.Health Care,2003; 12:33 -38.
  45. 45. Leonard M,Graham S,Bonacum D.The human factor:the critical importance of effective teamwork and communication in providing safe care.Qual.Saf.Health Care,2004; 13:85 -90.
  46. 46. Thomas EJ,Sherwood GD,Helmreich RL.Lessons from aviation:teamwork to improve patient safety.Nursing Economics,2003; 21 (5):241 -244.
  47. 47. Pape TM.Applying airline safety practices to medication administration.Medsurg Nursing,2003; 12(2):77-95.