Developing a Framework to Study and Improve Communication to Enhance Diagnostic Quality in the ED

项目总结/摘要： 医学诊断是人类大脑最困难的认知任务之一， 诊断过程的复杂性使其极易出错。在急诊科工作的临床医生 (EDs)特别容易犯诊断错误，因为决策发生在一个时间- 信息受限的上下文。美国每年约有1.41亿人次到艾德就诊。的保守估计 艾德就诊中5%的诊断错误转化为约700万例ED诊断错误， 近一半的患者有可能受到伤害。 非常需要了解艾德上发生的通信相关错误的影响 遭遇沟通中断可能发生在多个层面和在不同的点，在病人的 患者可能无法准确地将其症状或病史传达给 临床医生出于各种原因（例如，健康素养低、语言障碍、压力）。质量和数量 提供者之间的沟通也对诊断过程有直接影响。然而，我们最近 系统性审查显示，没有现有的框架或干预措施来调查沟通失败， 艾德上下文，从而抑制了有条理的测试。本次会议的目的是制定一个 ED特定框架，通过共识研究诊断决策过程中的沟通 与强大的相关利益攸关方团队合作的方法（即，医生、护士、病人、护理人员， 管理员）。我们的长期目标是通过改善沟通来减少艾德的诊断错误 在患者、临床医生和诊断团队的其他成员中。 我们这个共识小组的唯一具体目标是改进现有的沟通框架， ED特定的沟通框架，以提高诊断安全性。

PROJECT SUMMARY/ABSTRACT: Medical diagnosis is one of the most difficult cognitive tasks for the human mind, and the inherent uncertainty of the diagnostic process makes it highly susceptible to errors. Clinicians working in emergency departments (EDs) are particularly vulnerable to making diagnostic errors because decision-making occurs in a time- and information-constrained context. There are ~141 million annual ED visits in the US. A conservative estimate of diagnostic error present in 5% of ED visits translates to ~7 million cases of ED-based diagnostic errors per year, with nearly half having the potential for patient harm. There is a critical need to understand the impact of communication-related errors occurring over an ED encounter. Communication breakdowns can occur at multiple levels and at varied points during the patient’s diagnostic journey in the ED. Patients may not be able to accurately communicate their symptoms or history to clinicians for a variety for reasons (e.g., low health literacy, language barriers, stress). The quality and quantity of communication between providers has a direct impact on the diagnostic process as well. Yet, our recent systematic review revealed no existing framework or intervention for investigating communication failures in the ED context, thus inhibiting testing in a methodical manner. The purpose of this conference is to develop an ED-specific framework to study communication in the diagnostic decision-making process through consensus methods with a robust team of relevant stakeholders (i.e., physicians, nurses, patients, caregivers, administrators). Our long-term goal is to reduce diagnostic errors in the ED by improving communication among patients, clinicians, and other members of the diagnostic team. Our sole specific aim for this consensus panel is to refine existing communication frameworks and create an ED-specific communication framework to enhance diagnostic safety.