Division of General Internal Medicine, New York University School of Medicine, New York, NY, USA.
J Patient Saf. 2010 Sep;6(3):172-9. doi: 10.1097/pts.0b013e3181efe30a.
Missed and delayed breast cancer diagnoses are major sources of potential harm to patients and medical malpractice liability in the United States. Follow-up of abnormal mammogram results is an essential but challenging component of safe breast care. To explore the value of an inexpensive method to follow up abnormal test results, we examined a paper-based fail-safe system.
We examined a fail-safe system used to follow up abnormal mammograms at a primary care practice at an urban teaching hospital. We analyzed all abnormal mammogram reports and clinicians' responses to follow-up reminders. We characterized potential lapses identified in this system and used regression models to identify patient, provider, and test result characteristics associated with such lapses.
Clinicians responded to fail-safe reminders for 92% of 948 abnormal mammograms. Clinicians reported that they were unaware of the abnormal result in 8% of cases and that there was no follow-up plan in place for 3% of cases. Clinicians with more years of experience were more likely to be aware of the abnormal result (odds of being unaware per incremental year in practice, 0.92; 95% confidence interval, 0.88-0.97) and were more likely to have a follow-up plan.
A paper-based fail-safe system for abnormal mammograms is feasible in a primary care practice. However, special care is warranted to ensure full clinician adherence and address staff transitions and trainee-related issues.
在美国，漏诊和延误的乳腺癌诊断是对患者造成潜在伤害和医疗事故责任的主要原因。对异常乳房 X 光检查结果进行随访是安全乳房护理的重要但具有挑战性的组成部分。为了探索一种廉价的方法来跟踪异常的测试结果，我们研究了一种基于纸张的故障安全系统。
我们研究了在城市教学医院的初级保健实践中用于跟踪异常乳房 X 光检查结果的故障安全系统。我们分析了所有异常乳房 X 光报告和临床医生对随访提醒的反应。我们描述了该系统中发现的潜在疏忽，并使用回归模型确定与这些疏忽相关的患者、提供者和测试结果特征。
临床医生对 948 份异常乳房 X 光检查的故障安全提醒做出了 92%的回应。在 8%的病例中，临床医生报告他们不知道异常结果，在 3%的病例中没有制定后续计划。经验更丰富的临床医生更有可能了解异常结果（每增加 1 年实践经验，不知道异常结果的可能性为 0.92；95%置信区间，0.88-0.97），并且更有可能制定后续计划。
在初级保健实践中，异常乳房 X 光检查的基于纸张的故障安全系统是可行的。然而，需要特别注意以确保临床医生完全遵守，并解决员工过渡和与学员相关的问题。
