Factors that Enhance Diagnostic Imaging Safety in the Ambulatory Setting

最近一项对六个大型综合卫生系统进行的15年研究估计，每年每位患者需要进行1.18次成像检查 在美国进行，这相当于估计每个人进行了4亿次成像测试。 年，每年耗资约1000亿美元。四分之三的测试是在 虽然诊断成像主要是非侵入性的，但它具有安全风险， 可能会对患者造成伤害。此外，当利用诊断成像时，诊断错误被放大 不适当地和/或当没有闭环系统来监测诊断随访时。因此，识别 在门诊护理中诊断成像失败的促成因素是最重要的。 癌症是诊断诉讼案件中最常见的主要漏诊之一。肺癌是 乳腺癌是美国癌症死亡的主要原因，其次是女性乳腺癌。最常见的 CT扫描上可疑肺癌异常包括肺结节。因此，肺部的标准化随访 结节影响早期癌症检测，这为肺癌患者的生存提供了最佳机会。 同样，乳腺癌筛查是该国公共卫生的支柱，有3300多万妇女 每年接受乳房X光检查。乳腺成像报告和数据系统建议 （BIRADS）3类乳腺检查结果通常包括6个月随访成像。因此，我们计划评估 对于有肺结节和BIRADS 3类乳腺结果的患者，随访不理想。 我们提出了一个项目，从两个来源评估与诊断成像相关的诊断失败： (1)电子安全报告系统中与所有诊断成像模式相关的安全性事件，以及 (2)该机构的病人安全网倡议（PSNI），它结合了健康信息技术（HIT） 和护理协调方法，用于监测成像随访。我们专注于两个具体目标，以确定， 描述和评估诊断失败的影响因素。其中包括：（1）测量 提交至电子安全性报告的与诊断成像相关的安全性事件发生率 安全性报告系统;（2）测量次优随访的发生率， 评估社会技术因素对门诊次优诊断检查随访护理的影响 设置，特别是两个具有随访要求的临床显著结果：肺结节和BIRADS 第3类乳腺检查结果。 门诊的影像诊断受社会技术因素的影响， 进行不适当的检查以及次优的随访护理，所有这些都导致诊断性成像 失败这项研究将确定这些因素，并评估其对诊断检查随访护理的影响， 使用患者安全网倡议的门诊设置。

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.