Investigating Errors in Medical Imaging: Lessons for Practice From Medico legal Closed Claims
Investigating Errors in Medical Imaging: Lessons for Practice From Medico legal Closed Claims
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DOI：
10.1016/j.jacr.2015.03.025
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发表时间：
2015-09-01
影响因子：
4.5
通讯作者：
Runciman, William
中科院分区：
文献类型：
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作者：
Goergen, Stacy;Schultz, Tim;Runciman, William
目的：放射学在利用法医学数据提高患者安全方面落后于其他学科。本研究的目的是描述一个样本的关闭索赔文件，通知放射学实践和识别机会系统changes.Methods：回顾性分析443法医关闭索赔提供给放射学事件登记册。数据由2个为澳大利亚私人执业医生提供医疗赔偿保险的医疗辩护组织提供。我们计算了每种方式（CT、超声、放射摄影、MET、核医学）和某些程序的程序风险比（已结案索赔数据集的患病率除以澳大利亚政府在相应时间范围内报销的所有诊断成像程序的患病率）。对于每一个关闭的索赔，确定的事件类型，并进行了12个病人的安全field.Results的分类：误诊（延迟或未能正确读取成像）占62%的错误类型。导致索赔风险较高的方式和程序是：（风险比[RR] = 4.0，95% CI 2.9-5.5）;乳腺超声（RR = 2.8，95% CI 1.7-47）;总MET（RR = 3.4，95% CI 2.0-5.6）;全CT（RR = 1.9，95% CI 1.5-2.5）和妇产科超声（RR = 1.9，95% CI 1.4-2.4）。风险较低的模式和程序为：心脏超声（RR = 0.1，95% CI 0.0-0.8）;四肢X线摄影（RR = 0.7，95% CI 0.5-0.9）;和全X线摄影（RR = 0.8，95% CI 0.7-0.9）。信息，以告知患者的安全性分类是有限的，平均值为5.8 +/- 1.8（SD）fields availed.Conclusions：尽管其局限性，法医学数据值得进一步关注患者的安全分析。
Purpose: Radiology has lagged behind other disciplines in using medicolegal data to improve patient safety. The aim of this study was to characterize a sample of closed claims files to inform radiology practice and identify opportunities for system change.Methods: A retrospective analysis of 443 medicolegal closed claims provided to the Radiology Events Register. Data were provided by 2 medical defense organizations that provide medical indemnity insurance to Australian private practitioners. We calculated a procedural risk ratio (prevalence in the closed claims dataset divided by prevalence among all diagnostic imaging procedures reimbursed by the Australian Government over the corresponding timeframe) for each modality (CT, ultrasound, radiography, MET, nuclear medicine) and some procedures. For each closed claim, the incident type was determined, and a classification of 12 patient safety fields was conducted.Results: Misdiagnosis (delay or failure to correctly read imaging) accounted for 62% of error types. Modalities and procedures at higher risk of leading to a claim were: mammography (risk ratio [RR] = 4.0, 95% CI 2.9-5.5); breast ultrasound (RR = 2.8, 95% CI 1.7-47); total MET (RR = 3.4, 95% CI 2.0-5.6); total CT (RR = 1.9, 95% CI 1.5-2.5), and obstetrics and gynecology ultrasound (RR = 1.9, 95% CI 1.4-2.4). Lower-risk modalities and procedures were: cardiac ultrasound (RR = 0.1, 95% CI 0.0-0.8); radiography extremities (RR = 0.7, 95% CI 0.5-0.9); and total radiography (RR = 0.8, 95% CI 0.7-0.9). Information to inform patient safety classification was limited, with a mean of 5.8 +/- 1.8 (SD) fields available.Conclusions: Despite its limitations, medicolegal data deserve further attention from patient safety analysts.