In the mediation and handling of doctor-patient disputes in primary hospitals, in most cases, it is recognized that the medical party has made mistakes in the diagnosis and treatment behavior. It is an important responsibility for medical institutions and health administrative authorities to promptly detect and reduce or eliminate the occurrence of medical errors. Promoting the improvement and enhancement of medical quality in primary hospitals is of special significance. The promulgation of the local standard "Code Specification for Key Control Points of Medical Behavior" in Beijing has made it possible to analyze the root causes of standardization of medical errors in primary hospitals.

To explore the root causes of medical errors in primary hospitals under the perspective of local standards in Beijing and measures for improving medical quality.

We collected judgments from various levels of people's courts in Beijing from 2019 to 2022 regarding medical damage as a cause of action, involving medical errors in first level hospitals in Beijing, as the research object. We applied the Beijing local standard "Code Specification for Key Control Points of Medical Behavior" as the basis to summarize and analyze the root causes of medical errors, and provided improvement measures for improving medical quality.

From 2019 to 2022, there were a total of 127 judgments/rulings involving first level hospitals in Beijing that identified faults in the hospital's diagnosis and treatment behavior, based on medical damage as the cause of action. Among the root causes, the top one was poor communication between doctors and patients (32 cases, 25.2%), followed by unstable treatment plans (31 cases, 24.4%), lack of medical record writing (23 cases, 18.1%), and exceeding the scope of practice (17 cases, 13.4%). The proportion of over-range practice fault in different hospital categories was statistically significant (P<0.05). The pairwise comparison within groups showed that the proportion of over-range practice fault in tertiary hospitals was higher than that in primary hospitals and secondary hospitals, and the difference was statistically significant (P<0.016) .

The main root causes of medical errors in first level hospitals under the perspective of local standards in Beijing are poor communication quality between doctors and patients, unstable formulation of treatment plans, non-standard medical record writing, and exceeding the scope of practice. Targeted correction can improve the medical quality of first level hospitals and safeguard the legitimate rights and interests of both doctors and patients.

一级医院在医患纠纷的调解和处理中，多数案例中都会认定医方在诊疗行为中存在过错，而及时发现并减少或杜绝医疗过错的发生是医疗机构和卫生行政主管部门工作中的重要责任。促进一级医院医疗质量的改进与提升有着特别重要的意义。北京市地方标准《医疗行为关键控制点编码规范》的颁布使分析一级医院医疗过错标准化根原因成为可能。

探讨北京市地方标准视域下一级医院医疗过错的根原因及医疗质量提升改进措施。

收集北京市各级人民法院2019—2022年出具以医疗损害为案由的涉及北京市一级医院医疗过错的判决书作为研究对象，应用北京市地方标准《医疗行为关键控制点编码规范》作为依据进行医疗过错根原因的归纳分析，给出医疗质量提升的改进措施。

2019—2022年北京市各级人民法院以医疗损害为案由，涉及北京市一级医院的判决/裁定书中认定医院诊疗行为中存在过错的共127件。在各项根原因中，占据首位的是医患沟通不畅（32件，25.2%），此后依次是治疗方案欠稳妥（31件，24.4%）、病历书写欠缺（23件，18.1%）和超范围执业（17件，13.4%）。不同医院类别的超范围执业过错占比情况比较，差异有统计学意义（P<0.05）；组内两两比较结果显示，三级医院的超范围执业过错占比情况高于一级医院、二级医院（P<0.016）。

北京市地方标准视域下一级医院医疗过错主要根原因是医患沟通质量欠佳、治疗方案的制订欠稳妥、病历书写不规范和超范围执业，有针对性地加以改正能够改善一级医院的医疗质量，维护医患双方的合法权益。