在死亡或被转移到重症监护室的住院成年人中诊断错误
Andrew D Auerbach1, Tiffany M Lee1, Colin C Hubbard1
1Division of Hospital Medicine, Department of Medicine, University of California San Francisco.
在住院患者中,诊断错误很常见,影响了23%的死亡或被转移到重症监护室 (ICU) 的患者. 改善测试解释和患者评估可以减少这些有害的医疗错误.
科学领域:
- 医学错误研究 医学错误研究
- 对患者的安全性研究.
- 临床诊断 临床诊断 临床诊断
背景情况:
- 诊断错误是患者伤害的重要原因之一,但其在住院患者中的患病率和原因尚未得到充分记录.
- 了解这些错误对于改善医疗保健质量和患者结果至关重要.
研究的目的:
- 调查住院成年人诊断错误的患病率,潜在原因和患者伤害.
- 识别导致诊断错误的特定过程故障,并估计其减少潜力.
主要方法:
- 进行了一项回顾性队列研究,涉及29个美国学术医疗中心的成年住院患者随机样本.
- 被转移到ICU或死亡的患者记录 (2019年) 被临床医生审查以确定诊断错误,原因和危害.
- 使用多变量模型和调整比例归因分数 (aPAF) 来分析过程故障和诊断错误之间的关联.
主要成果:
- 在审查的患者记录中,23.0%的诊断错误发生.
- 在17.8%的患者中,诊断错误导致了暂时伤害,永久伤害或死亡.
- 患者评估问题 (aPAF,21.4%) 和测试排序/解释问题 (aPAF,19.9%) 是减少诊断错误的最大机会.
结论:
- 在住院成年人中,诊断错误很常见,特别是在那些死亡或被送往ICU的成年人中,并且与患者的重大伤害有关.
- 提高临床医生评估的准确性以及测试订购和解释的流程是减少诊断错误和提高患者安全的关键优先事项.
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