Campbell Samuel G, Croskerry Pat, Bond William F
Department of Emergency Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
Acad Emerg Med. 2007 Aug;14(8):743-9. doi: 10.1197/j.aem.2007.04.011. Epub 2007 May 30.
Correct and rapid diagnosis is pivotal to the practice of emergency medicine, yet the chaotic and ill-structured emergency department environment is fertile ground for the commission of diagnostic error. Errors may result from specific error-producing conditions (EPCs) or, more frequently, from an interaction between such conditions. These EPCs are often expedient and serve to shorten the decision making process in a high-pressure environment. Recognizing that they will inevitably exist, it is important for clinicians to understand and manage their dangers. The authors present a case of delayed diagnosis resulting from the interaction of a number of EPCs that produced a "perfect" situation to produce a missed or delayed diagnosis. They offer practical suggestions whereby clinicians may decrease their chances of becoming victims of these influences.
准确而迅速的诊断对于急诊医学实践至关重要，然而急诊科混乱且结构不良的环境却是产生诊断错误的温床。错误可能源于特定的错误产生条件（EPCs），或者更常见的是源于此类条件之间的相互作用。这些EPCs通常是权宜之计，有助于在高压环境中缩短决策过程。认识到它们将不可避免地存在，临床医生了解并应对其风险很重要。作者介绍了一个因多种EPCs相互作用导致诊断延迟的病例，这些EPCs共同营造了一个导致漏诊或诊断延迟的“完美”情形。他们提供了切实可行的建议，临床医生可借此降低受这些影响的几率。
