Understanding diagnostic processes in emergency departments: a mixed methods case study protocol.
Understanding diagnostic processes in emergency departments: a mixed methods case study protocol.
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了解急诊科的诊断过程：一个混合方法的案例研究协议。
DOI：
10.1136/bmjopen-2020-044194
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发表时间：
2021-09-24
期刊：
影响因子：
2.9
通讯作者：
Mahajan P
中科院分区：
文献类型：
--
作者：
Daniel M;Park S;Seifert CM;Chandanabhumma PP;Fetters MD;Wilson E;Singh H;Pasupathy K;Mahajan P
急诊科（艾德）的诊断过程涉及与信息系统接口以访问和记录信息的个人之间的多次交互。需要更好地了解诊断过程，以减少错误。本文介绍了一种研究协议，以映射诊断过程中的艾德作为基础，为发展未来的错误缓解策略。本研究的成人和儿科学术艾德采用前瞻性混合方法的案例研究设计，由ED特定的诊断决策模型（修改后的ED-国家科学院，工程和医学（NASEM）模型）和两个认知理论（双过程理论和分布式认知）。数据来源包括患者和护理团队互动的录音、电子健康记录数据、观察员现场记录和利益相关者访谈。多种定性分析方法将被用来探索诊断过程中的原位，包括系统信息流，人与人和人与系统的相互作用和影响认知的环境因素。本研究分为三个部分。第1部分涉及对诊断错误风险高的未分化症状患者的前瞻性现场观察，在整个护理过程中对每位患者进行随访。第2部分涉及在4小时的窗口内观察个人护理团队提供者，以捕捉他们的诊断工作流程，团队协调和多名患者之间的沟通。第3部分使用与关键利益相关者的访谈来了解诊断过程的不同观点，以及感知的优势和弱点，以丰富ED-NASEM诊断模型。密歇根大学机构审查委员会批准了本研究，HUM00156261。这项基础性工作将有助于确定诊断过程中的优势和弱点。此外，它将为患者、提供者和系统级干预措施的未来开发和测试提供信息，以减轻这些和其他ED中的错误并提高患者安全性。这项工作将通过期刊出版物和在国家和国际会议上的介绍加以传播。
Diagnostic processes in the emergency department (ED) involve multiple interactions among individuals who interface with information systems to access and record information. A better understanding of diagnostic processes is needed to mitigate errors. This paper describes a study protocol to map diagnostic processes in the ED as a foundation for developing future error mitigation strategies. This study of an adult and a paediatric academic ED uses a prospective mixed methods case study design informed by an ED-specific diagnostic decision-making model (the modified ED-National Academies of Sciences, Engineering and Medicine (NASEM) model) and two cognitive theories (dual process theory and distributed cognition). Data sources include audio recordings of patient and care team interactions, electronic health record data, observer field notes and stakeholder interviews. Multiple qualitative analysis methods will be used to explore diagnostic processes in situ, including systems information flow, human–human and human–system interactions and contextual factors influencing cognition. The study has three parts. Part 1 involves prospective field observations of patients with undifferentiated symptoms at high risk for diagnostic error, where each patient is followed throughout the entire care delivery process. Part 2 involves observing individual care team providers over a 4-hour window to capture their diagnostic workflow, team coordination and communication across multiple patients. Part 3 uses interviews with key stakeholders to understand different perspectives on the diagnostic process, as well as perceived strengths and vulnerabilities, in order to enrich the ED-NASEM diagnostic model. The University of Michigan Institutional Review Board approved this study, HUM00156261. This foundational work will help identify strengths and vulnerabilities in diagnostic processes. Further, it will inform the future development and testing of patient, provider and systems-level interventions for mitigating error and improving patient safety in these and other EDs. The work will be disseminated through journal publications and presentations at national and international meetings.
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