Thammasitboon Satid, Thammasitboon Supat, Singhal Geeta
Baylor College of Medicine, Texas Children's Hospital, Houston, TX.
Curr Probl Pediatr Adolesc Health Care. 2013 Oct;43(9):242-7. doi: 10.1016/j.cppeds.2013.07.004.
Several studies in primary care, internal medicine, and emergency departments show that rates of errors in test requests and result interpretations are unacceptably high and translate into missed, delayed, or erroneous diagnoses. Ineffective follow-up of diagnostic test results could lead to patient harm if appropriate therapeutic interventions are not delivered in a timely manner. The frequency of system-related factors that contribute directly to diagnostic errors depends on the types and sources of errors involved. Recent studies reveal that the errors and patient harm in the diagnostic testing loop have occurred mainly at the pre- and post-analytic phases, which are directed primarily by clinicians who may have limited expertise in the rapidly expanding field of clinical pathology. These errors may include inappropriate test requests, failure/delay in receiving results, and erroneous interpretation and application of test results to patient care. Efforts to address system-related factors often focus on technical errors in laboratory testing or failures in delivery of intended treatment. System-improvement strategies related to diagnostic errors tend to focus on technical aspects of laboratory medicine or delivery of treatment after completion of the diagnostic process. System failures and cognitive errors, more often than not, coexist and together contribute to the incidents of errors in diagnostic process and in laboratory testing. The use of highly structured hand-off procedures and pre-planned follow-up for any diagnostic test could improve efficiency and reliability of the follow-up process. Many feedback pathways should be established so that providers can learn if or when a diagnosis is changed. Patients can participate in the effort to reduce diagnostic errors. Providers should educate their patients about diagnostic probabilities and uncertainties. The patient-safety strategies focusing on the interface between diagnostic system and therapeutic intervention are strategies that involve both processes to facilitate appropriate follow-up and structural changes, such as the use of electronic tracking systems and patient navigation programs.
初级保健、内科和急诊科的多项研究表明，检验申请和结果解读中的错误率高得令人无法接受，会导致漏诊、延误诊断或误诊。如果不能及时进行适当的治疗干预，对诊断检验结果的无效跟进可能会对患者造成伤害。直接导致诊断错误的系统相关因素的发生频率取决于所涉及错误的类型和来源。最近的研究表明，诊断检验环节中的错误和对患者的伤害主要发生在分析前和分析后阶段，而这些阶段主要由临床医生主导，他们在迅速发展的临床病理学领域的专业知识可能有限。这些错误可能包括检验申请不当、接收结果失败/延迟以及对检验结果的错误解读和应用于患者护理。解决系统相关因素的努力通常集中在实验室检测中的技术错误或预期治疗的交付失败上。与诊断错误相关的系统改进策略往往侧重于检验医学的技术方面或诊断过程完成后的治疗交付。系统故障和认知错误往往并存，并共同导致诊断过程和实验室检测中的错误事件。对于任何诊断检验，使用高度结构化的交接程序和预先计划的跟进可以提高跟进过程的效率和可靠性。应该建立许多反馈途径，以便医疗服务提供者能够了解诊断是否或何时发生了变化。患者可以参与减少诊断错误的工作。医疗服务提供者应该向患者介绍诊断的可能性和不确定性。关注诊断系统与治疗干预之间接口的患者安全策略是涉及促进适当跟进的过程和结构变化的策略，例如使用电子跟踪系统和患者导航计划。
