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

项目摘要/摘要： 医学诊断是人类思维中最困难的认知任务之一，也是固有的不确定性 诊断过程的复杂性使其非常容易出错。急诊科的临床医生 (EDS)特别容易犯诊断错误，因为决策发生在一个时间段--和 信息受限的环境。在美国，每年约有1.41亿人次的急诊室来访。保守估计的 在5%的急诊室就诊中出现诊断错误相当于每年约700万例基于急诊室的诊断错误 去年，近一半的人有可能伤害病人。 迫切需要了解在ED上发生的与通信相关的错误的影响 相遇。沟通障碍可能发生在多个层面和不同的时间点，在患者的 急诊室的诊断之旅。患者可能无法准确地将他们的症状或病史传达给 临床医生出于各种原因(例如，健康素养低、语言障碍、压力)。质与量 提供者之间的沟通不畅对诊断过程也有直接影响。然而，我们最近 系统审查显示，没有现有的框架或干预措施来调查 教育背景，从而以一种有条不紊的方式抑制测试。这次会议的目的是制定一项 通过协商一致研究诊断决策过程中的沟通的ED特定框架 方法与相关利益相关者(即医生、护士、患者、护理人员、 管理员)。我们的长期目标是通过改善沟通来减少急诊室的诊断错误 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完善现有的沟通框架，并创建 特定于ED的通信框架，以增强诊断安全性。

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.