Use of patient complaints to identify diagnosis-related safety concerns: a mixed-method evaluation.
Use of patient complaints to identify diagnosis-related safety concerns: a mixed-method evaluation.
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DOI：
10.1136/bmjqs-2020-011593
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发表时间：
2021-12
影响因子：
5.4
通讯作者：
Singh H
中科院分区：
文献类型：
--
作者：
Giardina TD;Korukonda S;Shahid U;Vaghani V;Upadhyay DK;Burke GF;Singh H
患者投诉与不良事件和医疗事故索赔有关，但在患者安全改进方面未得到充分利用。系统地评估患者投诉数据的使用，以确定与诊断相关的安全问题，作为使用这些信息促进学习和改进的第一步。我们审查了2017年8月至12月(队列1)和2018年1月至6月(队列2)提交给美国大型医疗机构Geisinger的患者投诉。在盖辛格现有的投诉分类中，我们选择了更有可能与诊断问题相关的投诉。调查人员审阅了所有投诉摘要，并根据美国国家医学科学院对诊断错误的定义，确定了诊断错误所涉及的病例。对于所有“相关”病例，临床医生-审查员评估相关的调查报告和患者的医疗记录，以确定是否错过了做出正确或及时诊断的任何机会。在队列2中，我们选择了10%的“令人担忧”的案例样本来测试这个较小的实用样本，作为未来组织监控的概念证明。在队列1中，我们审查了1865个投诉摘要，确定了177个(9.5%)与报告有关。审查和分析发现了39个诊断错误。大多数被归类为临床护理问题(2769.2%)，定义为与临床医生在任何环境下提供的护理有关的关切/问题。在队列2中，我们回顾了2423例患者的投诉摘要，确定了310例(12.8%)与报告有关。10%的样本(n=31例)包含5个诊断错误。对队列1的定性分析确定了对持续和/或恶化症状、人际关系问题和诊断性测试的回访的关切。对患者投诉数据的分析和相应的医疗记录审查确定了患者和家属报告的诊断过程中的失败模式。卫生系统可以系统地分析关于患者投诉的现有数据，以监测诊断安全问题，并确定学习和改进的机会。
Patient complaints are associated with adverse events and malpractice claims but underused in patient safety improvement. To systematically evaluate the use of patient complaint data to identify safety concerns related to diagnosis as an initial step to using this information to facilitate learning and improvement. We reviewed patient complaints submitted to Geisinger, a large healthcare organisation in the USA, from August to December 2017 (cohort 1) and January to June 2018 (cohort 2). We selected complaints more likely to be associated with diagnostic concerns in Geisinger’s existing complaint taxonomy. Investigators reviewed all complaint summaries and identified cases as ‘concerning’ for diagnostic error using the National Academy of Medicine’s definition of diagnostic error. For all ‘concerning’ cases, a clinician-reviewer evaluated the associated investigation report and the patient’s medical record to identify any missed opportunities in making a correct or timely diagnosis. In cohort 2, we selected a 10% sample of ‘concerning’ cases to test this smaller pragmatic sample as a proof of concept for future organisational monitoring. In cohort 1, we reviewed 1865 complaint summaries and identified 177 (9.5%) concerning reports. Review and analysis identified 39 diagnostic errors. Most were categorised as ‘Clinical Care issues’ (27, 69.2%), defined as concerns/questions related to the care that is provided by clinicians in any setting. In cohort 2, we reviewed 2423 patient complaint summaries and identified 310 (12.8%) concerning reports. The 10% sample (n=31 cases) contained five diagnostic errors. Qualitative analysis of cohort 1 cases identified concerns about return visits for persistent and/or worsening symptoms, interpersonal issues and diagnostic testing. Analysis of patient complaint data and corresponding medical record review identifies patterns of failures in the diagnostic process reported by patients and families. Health systems could systematically analyse available data on patient complaints to monitor diagnostic safety concerns and identify opportunities for learning and improvement.
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影响因子：
3.5
作者：
Singh, Hardeep;Khanna, Arushi;Meyer, Ashley N. D.
通讯作者：
Meyer, Ashley N. D.
DOI：
10.1016/s1553-7250(14)40013-8
发表时间：
2014-03-01
影响因子：
2.3
作者：
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通讯作者：
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影响因子：
9.7
作者：
Giardina, Traber Davis;Haskell, Helen;Singh, Hardeep
通讯作者：
Singh, Hardeep
影响因子：
5.4
作者：
Singh H;Meyer AN;Thomas EJ
通讯作者：
Thomas EJ
影响因子：
7.4
作者：
Singh, Hardeep;Upadhyay, Divvy K.;Torretti, Dennis
通讯作者：
Torretti, Dennis