국내 정신병원 환자안전사고 현황 및 위해발생 요인 탐색 - 2021~2024 -

초록

This study analyzed the incidence and harm levels of patient safety incidents(PSIs) among inpatients in Korean psychiatric hospitals and explored factors associated with harm occurrence. A secondary data analysis was conducted using 2,051 PSIs reported to the Korea Patient Safety Reporting and Learning System(KOPS) from 2021 to 2024. Variables included hospital-related characteristics(nurse work shift, incident type, location) and patient-related characteristics(sex, age group, diagnosis). Harm level was dichotomized as "no harm"(near misses and no-harm events) and "harm"(mild or above). Descriptive statistics, chi-square tests, and binary logistic regression were applied. The number of reported incidents increased from 418 in 2021 to 602 in 2024, representing an average annual increase of 13.0%; harmful events accounted for 70.1% of all incidents. The most frequent incident types were falls(56.1%), medication errors(8.3%), and injuries(6.3%). Logistic regression revealed that, compared with medication incidents, injuries(OR=55.49), nutrition/meal-related incidents(OR=19.48), falls(OR=16.27), and suicide/ self-harm(OR=12.74) were significantly associated with higher harm risk. Among locations, shower rooms(OR=2.30), and among patient characteristics, the 60–79 age group(OR=2.62), were significant predictors of harm. The low rate of near-miss reporting highlights the urgent need to strengthen patient safety culture in Korean psychiatric hospitals. These findings provide empirical evidence to support the development of evidence-based safety policies and targeted interventions focused on high-risk incident types in psychiatric hospital settings.

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