Reducing errors made by emergency physicians in interpreting radiographs: longitudinal study
Reducing errors made by emergency physicians in interpreting radiographs: longitudinal study
复制标题
DOI：
10.1136/bmj.320.7237.737
复制
发表时间：
2000-03-18
影响因子：
--
通讯作者：
Nolan, TW
中科院分区：
文献类型：
--
作者：
Espinosa, JA;Nolan, TW
目的为了减少在急诊科X光片的解释错误的设计纵向研究设置医院急诊科干预措施所有工作人员在每月会议上审查所有临床显着差异。创建临床显著错误文件;该文件用于教学。后来，一个团队重新设计了这个过程。开发了一种用于解释射线照片的系统，该系统将被跟踪，而不管是一周中的哪一天或一天中的哪一个时间。所有标准X光片均直接交给急诊医生立即解读。放射科医生在12小时内审查的电影作为一个质量控制措施，如果发现一个重大的误解，病人被要求return.Main结果措施减少临床显着错误（如错过骨折或异物）的数量在急诊科读片。放射科医师的错误率和召回程序的效果的数据是不可用的，所以可靠性建模被用来评估这些对整体safety.Results的影响后，初步改进的假阴性错误率从3%（95%置信区间2.8%至3.2%）下降到1.2%（1.03%至1.37%）。在重新设计流程后，这一比例进一步下降至0.3%（0.26%至0.34%）。可靠性模型显示，每1000例潜在不良反应的死亡数从改进前的19例下降到改进后的-3例，未减轻的不良反应从改进前的2.2/1000下降到改进后的0.16/1000。假设95%结论X光片解释系统优化了临床医生的技能，并包含可靠的流程，减轻错误可以显著降低错误率。
Objectives To reduce errors made in the interpretation of radiographs in an emergency department.Design Longitudinal study.Setting Hospital emergency department.Interventions All staff reviewed all clinically significant discrepancies at monthly meetings. A file of clinically significant errors was created; the file was used for teaching. Later a team redesigned the process. A system was developed for interpreting radiographs that would be followed regardless of the day of the week or time of day. All standard radiographs were brought directly to the emergency physician for immediate interpretation. Radiologists reviewed the films within 12 hours as a quality control measure, and if a significant misinterpretation was found patients were asked to return.Main outcome measures Reduction in number of clinically significant errors (such as missed fractures or foreign bodies) on radiographs read in the emergency department. Data on the error rate for radiologists and the effect of the recall procedure were not available so reliability modelling was used to assess the effect of these on overall safety.Results After the initial improvements the rate of false negative errors fell from 3% (95% confidence interval 2.8% to 3.2%)to 1.2% (1.03% to 1.37%). After the processes were redesigned it fell further to 0.3% (0.26% to 0.34%). Reliability modelling showed that die number of potential adverse effects per 1000 cases fell from 19 before the improvements to-3 afterwards and unmitigated adverse effects fell from 2.2/1000 before to 0.16/1000 afterwards, assuming 95% success in calling patients back.Conclusion Systems of radiograph interpretation that optimise the skills of an clinicians involved and contain reliable processes for mitigating errors can reduce error rates substantially.