Singh Hardeep, Naik Aanand Dinkar, Rao Raghuram, Petersen Laura Ann
Houston Center for Quality of Care and Utilization Studies, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX 77030, USA.
J Gen Intern Med. 2008 Apr;23(4):489-94. doi: 10.1007/s11606-007-0393-z.
Diagnostic errors are poorly understood despite being a frequent cause of medical errors. Recent efforts have aimed to advance the "basic science" of diagnostic error prevention by tracing errors to their most basic origins. Although a refined theory of diagnostic error prevention will take years to formulate, we focus on communication breakdown, a major contributor to diagnostic errors and an increasingly recognized preventable factor in medical mishaps. We describe a comprehensive framework that integrates the potential sources of communication breakdowns within the diagnostic process and identifies vulnerable steps in the diagnostic process where various types of communication breakdowns can precipitate error. We then discuss potential information technology-based interventions that may have efficacy in preventing one or more forms of these breakdowns. These possible intervention strategies include using new technologies to enhance communication between health providers and health systems, improve patient involvement, and facilitate management of information in the medical record.
尽管诊断错误是医疗差错的常见原因,但人们对其了解甚少。最近的努力旨在通过将错误追溯到最基本的根源来推进诊断错误预防的“基础科学”。虽然完善的诊断错误预防理论需要数年时间才能形成,但我们关注沟通障碍,这是诊断错误的主要促成因素,也是医疗事故中日益被认识到的可预防因素。我们描述了一个综合框架,该框架整合了诊断过程中沟通障碍的潜在来源,并确定了诊断过程中各种类型的沟通障碍可能导致错误的脆弱环节。然后,我们讨论了基于信息技术的潜在干预措施,这些措施可能有效地预防这些障碍的一种或多种形式。这些可能的干预策略包括使用新技术来加强医疗服务提供者与医疗系统之间的沟通、提高患者的参与度以及促进病历信息的管理。