BMJ Qual Saf. 2013 Oct;22 Suppl 2(Suppl 2):ii21-ii27. doi: 10.1136/bmjqs-2012-001615. Epub 2013 Jun 15.
A wide variety of research studies suggest that breakdowns in the diagnostic process result in a staggering toll of harm and patient deaths. These include autopsy studies, case reviews, surveys of patient and physicians, voluntary reporting systems, using standardised patients, second reviews, diagnostic testing audits and closed claims reviews. Although these different approaches provide important information and unique insights regarding diagnostic errors, each has limitations and none is well suited to establishing the incidence of diagnostic error in actual practice, or the aggregate rate of error and harm. We argue that being able to measure the incidence of diagnostic error is essential to enable research studies on diagnostic error, and to initiate quality improvement projects aimed at reducing the risk of error and harm. Three approaches appear most promising in this regard: (1) using 'trigger tools' to identify from electronic health records cases at high risk for diagnostic error; (2) using standardised patients (secret shoppers) to study the rate of error in practice; (3) encouraging both patients and physicians to voluntarily report errors they encounter, and facilitating this process.
大量研究表明，诊断过程中的失误会导致惊人的伤害和患者死亡。这些研究包括尸检研究、案例回顾、患者和医生调查、自愿报告系统、使用标准化患者、二次审查、诊断测试审核和已决索赔审查。尽管这些不同的方法提供了关于诊断错误的重要信息和独特见解，但每种方法都有其局限性，没有一种方法能够很好地确定实际实践中的诊断错误发生率，也无法确定错误和伤害的总发生率。我们认为，能够衡量诊断错误的发生率对于开展诊断错误的研究以及启动旨在降低错误和伤害风险的质量改进项目至关重要。在这方面，有三种方法似乎最有希望：（1）使用“触发工具”从电子健康记录中识别出高风险的诊断错误病例；（2）使用标准化患者（秘密购物者）来研究实践中的错误率；（3）鼓励患者和医生自愿报告他们遇到的错误，并为这一过程提供便利。
