Root Cause Analysis Reports Help Identify Common Factors In Delayed Diagnosis And Treatment Of Outpatients
Root Cause Analysis Reports Help Identify Common Factors In Delayed Diagnosis And Treatment Of Outpatients
复制标题
DOI：
10.1377/hlthaff.2013.0130
复制
发表时间：
2013-08-01
期刊：
影响因子：
9.7
通讯作者：
Singh, Hardeep
中科院分区：
文献类型：
--
作者：
Giardina, Traber Davis;King, Beth J.;Singh, Hardeep
诊断和治疗的延误被广泛认为是对门诊安全的威胁。然而，很少有研究已经确定并描述了哪些因素导致延迟，可能会导致患者在门诊设置的伤害。我们分析了111份根本原因分析报告，这些报告调查了2005年至2012年期间提交给退伍军人事务国家患者安全中心的此类延迟。报告中指出的最常见的影响因素包括因随访计划不充分而导致的协调问题、因未具体说明的原因而延迟的安排、对测试结果的跟踪不充分以及缺乏跟踪需要短期随访的患者的系统。其他促成因素是团队层面的决策问题，造成供应商和供应商之间的紧迫性和供应商的缺乏认识或对病人的情况知识的错误沟通;和供应商，病人和其他医疗保健团队成员之间的沟通失败。我们的研究结果表明，为了支持《平价医疗法案》和《国家质量战略》中的医疗目标，即使是相对复杂的电子健康记录系统也需要改进。与此同时，政策措施应支持实施更严格的跨专业团队合作原则的计划，并可能奖励使用这些原则，以改善门诊沟通和协调。
Delays in diagnosis and treatment are widely considered to be threats to outpatient safety. However, few studies have identified and described what factors contribute to delays that might result in patient harm in the outpatient setting. We analyzed 111 root cause analysis reports that investigated such delays and were submitted to the Veterans Affairs National Center for Patient Safety in the period 2005-12. The most common contributing factors noted in the reports included coordination problems resulting from inadequate follow-up planning, delayed scheduling for unspecified reasons, inadequate tracking of test results, and the absence of a system to track patients in need of short-term follow-up. Other contributing factors were team-level decision-making problems resulting from miscommunication of urgency between providers and providers' lack of awareness of or knowledge about a patient's situation; and communication failures among providers, patients, and other health care team members. Our findings suggest that to support care goals in the Affordable Care Act and the National Quality Strategy, even relatively sophisticated electronic health record systems will require enhancements. At the same time, policy initiatives should support programs to implement, and perhaps reward the use of, more rigorous interprofessional teamwork principles to improve outpatient communication and coordination.