Houston Veterans Affairs Center for Innovation in Quality, Effectiveness, and Safety, Houston, TX, USA.
Health Aff (Millwood). 2013 Aug;32(8):1368-75. doi: 10.1377/hlthaff.2013.0130.
Delays in diagnosis and treatment are widely considered to be threats to outpatient safety. However, few studies have identified and described what factors contribute to delays that might result in patient harm in the outpatient setting. We analyzed 111 root cause analysis reports that investigated such delays and were submitted to the Veterans Affairs National Center for Patient Safety in the period 2005-12. The most common contributing factors noted in the reports included coordination problems resulting from inadequate follow-up planning, delayed scheduling for unspecified reasons, inadequate tracking of test results, and the absence of a system to track patients in need of short-term follow-up. Other contributing factors were team-level decision-making problems resulting from miscommunication of urgency between providers and providers' lack of awareness of or knowledge about a patient's situation; and communication failures among providers, patients, and other health care team members. Our findings suggest that to support care goals in the Affordable Care Act and the National Quality Strategy, even relatively sophisticated electronic health record systems will require enhancements. At the same time, policy initiatives should support programs to implement, and perhaps reward the use of, more rigorous interprofessional teamwork principles to improve outpatient communication and coordination.
延迟诊断和治疗被广泛认为是门诊安全的威胁。然而，很少有研究确定并描述哪些因素会导致门诊患者受到伤害的延迟，我们分析了 2005 年至 2012 年期间向退伍军人事务部国家患者安全中心提交的 111 份根本原因分析报告，这些报告调查了此类延迟。报告中指出的最常见的促成因素包括由于随访计划不足而导致的协调问题、由于不明原因而延迟安排、对测试结果的跟踪不足，以及缺乏跟踪需要短期随访的患者的系统。其他促成因素包括提供者之间沟通不畅导致的团队层面决策问题，以及提供者对患者情况缺乏了解或认识；提供者、患者和其他医疗团队成员之间的沟通失败。我们的研究结果表明，为了支持《平价医疗法案》和《国家质量战略》中的护理目标，即使是相对复杂的电子健康记录系统也需要增强。同时，政策举措应支持实施计划，并可能奖励使用更严格的跨专业团队合作原则，以改善门诊沟通和协调。
