一个安全II方法从实践中学习急诊部门的诊断过程中的变化:一个行动研究研究
Rick Roos1,2, Laura Zwaan3, Myrthe Maranus3
1Department of Internal Medicine, Haga Teaching Hospital, The Hague, The Netherlands.
Diagnosis (Berlin, Germany)
|October 13, 2025
概括
这项研究使用了安全II方法,通过从日常实践变化中学习来改进急诊室 (ED) 诊断过程. 这种新的方法成功地确定并实施了实践变化,提高了患者的安全性.
科学领域:
- 改善医疗保健 改善医疗保健
- 患者安全 患者安全
- 临床诊断 临床诊断 临床诊断
背景情况:
- 传统的患者安全侧重于错误 (安全-I).
- 一种新的安全II方法检查了日常实践的变化,以提高安全性.
- 在急诊室 (ED) 的诊断过程是复杂的,并提供了改进的机会.
研究的目的:
- 应用安全II方法,使用行动研究来识别和学习ED诊断过程中的实践变异.
- 根据已识别的最佳实践来设计和实施实践变化.
- 评估实施的变革的有效性和利益相关者的接受.
主要方法:
- 单中心研究采用行动研究与三个观察周期.
- 专注于识别日常诊断过程中的实践变化,而不仅仅是错误.
- 利益相关者共同创作会议,讨论变化,并确定潜在的改进.
- 实施和评估选择的最佳实践,随着实践的变化.
主要成果:
- 观察了40个诊断过程,揭示了临床医生的适应能力和需要改进的领域.
- 实施了五种最佳实践:ED预告文档模板,数字资源指南,顾问监督,分拣血液采样和扩展ED血液测试.
- 实施的变化受到好评,采用率为67-100%.
结论:
- 安全II方法与行动研究和直接观察相结合,可以有效地改善ED诊断过程.
- 这种方法成功地识别了导致受欢迎和有影响的实践变化的实践变化.
- 该研究表明,通过从常规临床实践中学习来提高患者安全的可行策略.
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