The Next Organizational Challenge: Finding and Addressing Diagnostic Error
The Next Organizational Challenge: Finding and Addressing Diagnostic Error
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DOI：
10.1016/s1553-7250(14)40013-8
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发表时间：
2014-03-01
影响因子：
2.3
通讯作者：
Kanter, Michael H.
中科院分区：
文献类型：
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作者：
Graber, Mark L.;Trowbridge, Robert;Kanter, Michael H.
背景资料：尽管医疗保健组织（HCOs）非常关注提高医疗保健的安全性，但迄今为止的努力几乎完全针对治疗相关问题。文献证实，HCO用于识别不良医疗事件的方法在发现诊断错误方面并不有效，因此最初的挑战是识别诊断错误的案例。为什么卫生保健组织需要参与：HCO专注于许多与质量和安全相关的操作和临床问题，包括绩效指标。然而，关注诊断错误的理由是基于以下四点：（1）诊断错误是常见且有害的;（2）高质量的医疗保健需要高质量的诊断;（3）诊断错误的代价高昂;（4）HCO在减少诊断错误方面处于领先地位。目前识别诊断错误的方法，如发生率筛选、事件报告、尸检和同行评审，并不是为了检测诊断问题（或一般的遗漏问题）和/或依赖于自愿报告。认识到现有的工具是不够的，刺激了努力，以确定新的工具，可以用来发现诊断错误或故障的诊断过程中，与错误相关联。新的方法缅因州医疗中心的情况下发现的诊断错误，促进医生和凯泽永久的电子健康记录为基础的报告，检测过程故障的后续异常findings-in case studies.Conclusion：通过提高认识和实施有针对性的方案，解决诊断错误，HCOs可能开始发挥重要作用，在解决诊断错误的问题。
Background: Although health care organizations (HCOs) are intensely focused on improving the safety of health care, efforts to date have almost exclusively targeted treatment-related issues. The literature confirms that the approaches HCOs use to identify adverse medical events are not effective in finding diagnostic errors, so the initial challenge is to identify cases of diagnostic error.Why Health Care Organizations Need to Get Involved: HCOs are preoccupied with many quality- and safety-related operational and clinical issues, including performance measures. The case for paying attention to diagnostic errors, however, is based on the following four points: (1) diagnostic errors are common and harmful, (2) high-quality health care requires high-quality diagnosis, (3) diagnostic errors are costly, and (4) HCOs are well positioned to lead the way in reducing diagnostic error.Finding Diagnostic Errors: Current approaches to identifying diagnostic errors, such as occurrence screens, incident reports, autopsy, and peer review, were not designed to detect diagnostic issues (or problems of omission in general) and/or rely on voluntary reporting. The realization that the existing tools are inadequate has spurred efforts to identify novel tools that could be used to discover diagnostic errors or breakdowns in the diagnostic process that are associated with errors. New approaches-Maine Medical Center's case-finding of diagnostic errors by facilitating direct reports from physicians and Kaiser Permanente's electronic health record-based reports that detect process breakdowns in the followup of abnormal findings-are described in case studies.Conclusion: By raising awareness and implementing targeted programs that address diagnostic error, HCOs may begin to play an important role in addressing the problem of diagnostic error.