住院患者的不良诊断事件:一个单中心,回顾性队列研究
Anuj K Dalal1,2,3, Savanna Plombon4,3, Kaitlyn Konieczny4
1Department of Medicine, Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA adalal1@bwh.harvard.edu.
有害的诊断错误 (DEs) 影响了14名通用医学患者中的1名,大多数是可以预防的. 目前的监测方法低估了DE的患病率,强调了需要改进的检测策略.
科学领域:
- 医疗保健的质量和安全
- 医学错误研究 医学错误研究
- 诊断准确性研究 诊断准确性研究
背景情况:
- 传统的不良事件监测低估了医院护理中的有害诊断错误.
- 诊断错误是一个重要的,但往往隐藏的,患者安全问题.
研究的目的:
- 估计在通用医学住院治疗中有害,可预防和严重有害的诊断错误的患病率.
- 识别有害的DE的特征和相关的过程故障.
主要方法:
- 追溯性队列研究,采用9147例住院病人的分层抽样.
- 使用了Safer Dx仪器和修改的诊断错误评估和研究分类学来进行错误评估.
- 专家小组审查了不一致或不确定的案件.
主要成果:
- 据估计,有害DES的患病率为7.2%,其中6.1%是可以预防的,1.1%是严重有害的.
- 延迟是有害的DEs最常见的特征 (61.9%).
- 评估,测试和咨询过程中的流程故障与有害的DEs有显著的关联.
结论:
- 大约每14名通用医学住院患者中就有1名患有有害的诊断错误,其中大多数是可以预防的.
- 目前用于监测诊断错误的方法是不够的.
- 需要新的方法来准确识别和解决医疗保健机构的诊断错误.
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