Houston Veterans Affairs Health Services Research and Development Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA.
Pediatrics. 2010 Jul;126(1):70-9. doi: 10.1542/peds.2009-3218. Epub 2010 Jun 21.
We surveyed pediatricians to elicit their perceptions regarding frequency, contributing factors, and potential system- and provider-based solutions to address diagnostic errors.
Academic, community, and trainee pediatricians (N = 1362) at 3 tertiary care institutions and 109 affiliated clinics were invited to complete the survey anonymously through an Internet survey administration service between November 2008 and May 2009.
The overall response rate was 53% (N = 726). More than one-half (54%) of respondents reported that they made a diagnostic error at least once or twice per month; this frequency was markedly higher (77%) among trainees. Almost one-half (45%) of respondents reported diagnostic errors that harmed patients at least once or twice per year. Failure to gather information through history, physical examination, or chart review was the most-commonly reported process breakdown, whereas inadequate care coordination and teamwork was the most-commonly reported system factor. Viral illnesses being diagnosed as bacterial illnesses was the most-commonly reported diagnostic error, followed by misdiagnosis of medication side effects, psychiatric disorders, and appendicitis. Physicians ranked access to electronic health records and close follow-up of patients as strategies most likely to be effective in preventing diagnostic errors.
Pediatricians reported making diagnostic errors relatively frequently, and patient harm from these errors was not uncommon.
我们调查了儿科医生，以了解他们对诊断错误的频率、促成因素以及潜在的系统和提供者为基础的解决方案的看法。
邀请了 3 家三级保健机构和 109 家附属诊所的学术、社区和受训儿科医生（N=1362）通过互联网调查管理服务在 2008 年 11 月至 2009 年 5 月期间匿名完成调查。
总的回复率为 53%（N=726）。超过一半（54%）的受访者报告说他们每月至少犯一次或两次诊断错误；受训者的这一频率明显更高（77%）。几乎一半（45%）的受访者报告说，他们每年至少有一次或两次因诊断错误而伤害患者。未能通过病史、体检或病历回顾收集信息是最常报告的流程中断，而不足的医疗协调和团队合作是最常报告的系统因素。将病毒病误诊为细菌病是最常报告的诊断错误，其次是药物副作用、精神障碍和阑尾炎的误诊。医生们认为，获取电子健康记录和密切随访患者是预防诊断错误最有效的策略。
儿科医生报告说他们相对频繁地犯诊断错误，而且这些错误对患者造成的伤害并不罕见。
