实施电子触发器,以识别紧急部门的诊断错误
Viralkumar Vaghani1, Ashish Gupta1, Usman Mir1
1Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas.
电子触发器 (e-trigger) 有效地识别了急诊室 (ED) 中错过的诊断机会,突出了系统干预的必要性,以减少诊断错误对患者的伤害.
科学领域:
- 医疗信息学 医疗信息学
- 患者安全 患者安全
- 紧急医疗 紧急医疗
背景情况:
- 在急诊室 (EDs) 中错误诊断可能会导致患者遭受重大且可预防的伤害.
- 在诊断 (MODs) 中有效识别错过的机会对于改善患者的治疗结果至关重要.
- 电子健康记录 (EHR) 数据为开发自动检测系统提供了潜力.
研究的目的:
- 开发和实施一套电子触发器 (e-trigger) 套件,用于识别ED环境中的MOD.
- 在一项大规模的回顾性研究中评估这些电子触发器的性能.
- 分析电子触发器检测到的MOD的特征和影响.
主要方法:
- 对1321个退伍军人事务医疗保健网站的ED访问进行了回顾性审查.
- 开发和实施基于规则的电子触发器,针对MOD的六种高风险表现.
- 医生对随机选择的标记记录进行审查,以确定MOD存在,诊断故障和患者伤害.
主要成果:
- 电子触发器应用于数以百万计的ED访问,识别了许多潜在的MOD,包括中风,腹部疼痛,ED返回,医院返回,症状-疾病二元并测试结果.
- 对MOD的积极预测值 (PPV) 根据触发器类型而异,中风 (47.0%) 和测试结果 (52.4%) 显示了更高的PPV.
- 诊断过程中最常见的崩涉及患者与临床医生的接触,并且MOD的很大一部分导致了中度至严重的患者伤害.
结论:
- 基于规则的电子触发器是后期检测ED诊断中错失机会的宝贵工具.
- 这些发现强调了针对ED工作系统因素的干预措施的迫切需要,特别是患者与临床医生的接触.
- 尽量减少诊断错误造成的伤害,需要在系统层面进行改进,以支持紧急护理中的准确和及时诊断.
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