Recommendations for using the Revised Safer Dx Instrument to help measure and improve diagnostic safety
Recommendations for using the Revised Safer Dx Instrument to help measure and improve diagnostic safety
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DOI：
10.1515/dx-2019-0012
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发表时间：
2019-12-01
期刊：
影响因子：
3.5
通讯作者：
Meyer, Ashley N. D.
中科院分区：
文献类型：
--
作者：
Singh, Hardeep;Khanna, Arushi;Meyer, Ashley N. D.
病历仍然是检查诊断过程最有用和最容易获取的信息来源之一。然而，诊断错误的病历审查研究经常使用主观判断，并发现在确定是否存在诊断错误时，审查者之间的评估者间一致性较低。在我们之前的工作中，我们开发了一种结构化数据收集工具，称为 Safer Dx 工具，其中包含客观标准，以提高初级保健中诊断错误评估的准确性。本文就临床医生和医疗保健组织如何使用修订版 Safer Dx 工具来识别和理解错失的机会以做出正确和及时的诊断提出了建议。该工具的修订解决了最初使用期间发现的方法和实施问题，并包括对该工具的改进，以允许在所有医疗保健环境中更广泛的应用。除了利用在多个医疗保健环境中试用该仪器所获得的知识之外，我们还从在涉及紧急护理、住院护理和重症监护病房环境的研究中使用该仪器的多名研究人员那里获得了见解。这使我们能够增强和扩展这个先前经过验证的数据收集工具的范围。在本文中，我们描述了改进过程，并为在广泛的医疗保健环境中应用和使用修订版 Safer Dx 仪器提供了建议。该仪器可以帮助用户以标准化的方式识别潜在的诊断错误，以便进一步分析和安全改进工作，并为临床医生反馈和反思提供数据。随着临床医生和卫生系统的广泛采用和使用，修订版 Safer Dx 仪器可以帮助推动测量和减少诊断错误的科学向前发展。
The medical record continues to be one of the most useful and accessible sources of information to examine the diagnostic process. However, medical record review studies of diagnostic errors have often used subjective judgments and found low inter-rater agreement among reviewers when determining the presence or absence of diagnostic error. In our previous work, we developed a structured data-collection instrument, called the Safer Dx Instrument, consisting of objective criteria to improve the accuracy of assessing diagnostic errors in primary care. This paper proposes recommendations on how clinicians and health care organizations could use the Revised Safer Dx Instrument in identifying and understanding missed opportunities to make correct and timely diagnoses. The instrument revisions addressed both methodological and implementation issues identified during initial use and included refinements to the instrument to allow broader application across all health care settings. In addition to leveraging knowledge from piloting the instrument in several health care settings, we gained insights from multiple researchers who had used the instrument in studies involving emergency care, inpatient care and intensive care unit settings. This allowed us to enhance and extend the scope of this previously validated data collection instrument. In this paper, we describe the refinement process and provide recommendations for application and use of the Revised Safer Dx Instrument across a broad range of health care settings. The instrument can help users identify potential diagnostic errors in a standardized way for further analysis and safety improvement efforts as well as provide data for clinician feedback and reflection. With wider adoption and use by clinicians and health systems, the Revised Safer Dx Instrument could help propel the science of measuring and reducing diagnostic errors forward.