Factors that Enhance Diagnostic Imaging Safety in the Ambulatory Setting

最近对六个大型综合卫生系统进行的一项为期15年的研究估计，每个患者每年进行1.18次成像测试 在美国进行了大约4亿次成像测试 每年的成本约为1000亿美元。其中四分之三的测试是在 虽然诊断成像主要是非侵入性的，但它存在以下安全风险 可能会对病人造成潜在伤害。此外，当使用诊断成像时，诊断错误会被放大 不适当的和/或当没有闭环系统来监测诊断跟踪时。因此，识别 在门诊护理中，导致诊断成像失败的因素是最重要的。 癌症是诊断诉讼案件中最常见的主要漏诊之一。肺癌是最重要的 在美国，癌症是导致死亡的主要原因，其次是女性乳腺癌。最常见的 CT上可疑的肺癌异常包括肺结节。因此，标准化的肺部随访 结节影响早期癌症检测，这为肺癌患者提供了最好的生存机会。 同样，在这个拥有3300万妇女的国家，乳腺癌筛查是公共卫生的支柱 每年都会接受乳房X光检查。关于乳房成像报告和数据系统的建议 (BIRADS)3类乳房发现通常包括6个月的随访成像。因此，我们计划评估 对患有肺结节和BIRADS 3类乳腺病变的患者进行次优随访。 我们提出了一个项目，评估与诊断成像相关的诊断故障，这些故障来自两个来源： (1)与来自电子安全报告系统的所有诊断成像方式有关的安全事件；以及 (2)该机构的患者安全网倡议(PSNI)，它结合了医疗信息技术(HIT) 以及监测影像随访的护理协调方法。我们专注于两个具体的目标来确定， 描述并评估导致诊断失败的因素。这些措施包括(1)测量 与提交给电子设备的安全报告中的诊断成像相关的安全事件的发生率 安全报告制度；以及(2)衡量次优随访的发生率，并全面 评估社会技术因素对门诊次优诊断检查随访护理的影响 背景，特别是两个临床上有意义的发现和随访要求：肺结节和BIRADS 3类乳房发现。 门诊环境中的诊断成像受到社会技术因素的影响，这些因素有助于 不适当的检查表现以及不理想的后续护理，所有这些都导致了诊断成像 失败。本研究将确定这些因素，并评估它们对诊断检查随访护理的影响。 使用患者安全网倡议的门诊环境。

A recent 15-year study of six large integrated health systems estimated 1.18 imaging tests per patient per year were performed in the United States, which amounts to an estimated 400 million imaging tests performed each year, at a cost of approximately $100 billion annually. Three quarters of these tests are performed in the ambulatory setting and although diagnostic imaging is predominantly non-invasive, it carries safety risks that could potentially harm patients. In addition, diagnostic errors are magnified when diagnostic imaging is utilized inappropriately and/or when there is no closed-loop system to monitor diagnostic follow-up. Thus, identifying contributing factors to diagnostic imaging failures in ambulatory care is of utmost importance. Cancer is one of the most common leading missed diagnoses in diagnostic litigation cases. Lung cancer is the leading cause of cancer deaths in the United States, followed by breast cancer in women. The most common suspicious abnormality for lung cancer on CT scan include lung nodules. Thus, standardized follow-up of lung nodules impacts early cancer detection, which provides the best chance for survival in lung cancer patients. Similarly, breast cancer screening is a mainstay of public health in the country with over 33 million women receiving mammograms each year. Recommendation for Breast Imaging Reporting and Data System (BIRADS) category 3 breast findings typically includes 6-month follow-up imaging. We therefore plan to assess suboptimal follow-up for patients with lung nodules and BIRADS category 3 breast findings. We propose a project that assesses diagnostic failures that are related to diagnostic imaging from two sources: (1) safety events related to all modalities of diagnostic imaging from an electronic safety reporting system, and (2) the institution's Patient Safety Net Initiative (PSNI), which combines Health Information Technology (HIT) and Care Coordination approaches for monitoring imaging follow-up. We focus on two specific aims to identify, characterize and evaluate contributing factors to diagnostic failures. These include (1) To measure the incidence of safety events that are related to diagnostic imaging from safety reports submitted to an electronic safety reporting system; and (2) To measure the incidence of suboptimal follow-up and comprehensively assess the impact of socio-technical factors on suboptimal diagnostic exam follow-up care in the ambulatory setting, specifically for two clinically significant findings with follow-up requirements: lung nodules and BIRADS category 3 breast findings. Diagnostic imaging in the ambulatory setting is influenced by socio-technical factors that contribute to performance of inappropriate exams as well as suboptimal follow-up care, all leading to diagnostic imaging failures. This study will identify these factors and assess their impact on diagnostic exam follow-up care in the ambulatory setting using the Patient Safety Net Initiative.