医学问题解决与治疗错误和疾病种类之间的关系。

The relation of medical problem solving and therapeutic errors to disease categories.

作者信息

Weinberg N S

机构信息

Department of Medicine, Emerson Hospital, Concord, Massachusetts 01742.

出版信息

QRB Qual Rev Bull. 1989 Sep;15(9):266-72. doi: 10.1016/s0097-5990(16)30303-7.

DOI:10.1016/s0097-5990(16)30303-7

PMID:2510109

Abstract

Review of 146 internal medicine cases at Emerson Hospital in Concord, Massachusetts, revealed significant variations in the patterns of physician error and medical problem solving for five diseases: recurrent congestive heart failure, transient ischemic attacks, recurrent cerebrovascular accidents, upper gastrointestinal hemorrhage, and acute bacterial pneumonia. Reviewers used general criteria to identify quality issues, which were separated into six error categories: insufficient data acquisition, inadequate hypothesis generation, inattention to or misinterpretation of cues, inappropriate or mismanaged therapy, delayed or missed diagnoses, and delayed treatment. The most common errors were inadequate hypothesis generation (38%) and inattention to or misinterpretation of cues (32%). Inappropriate or mismanaged therapy was found in 21% of cases.

摘要

对马萨诸塞州康科德市爱默生医院的146例内科病例进行回顾后发现，在复发性充血性心力衰竭、短暂性脑缺血发作、复发性脑血管意外、上消化道出血和急性细菌性肺炎这五种疾病的医生失误模式和医疗问题解决方式上存在显著差异。评审人员使用一般标准来识别质量问题，这些问题被分为六个失误类别：数据采集不足、假设生成不充分、对线索的忽视或错误解读、治疗不当或管理不善、诊断延迟或漏诊以及治疗延迟。最常见的失误是假设生成不充分（38%）和对线索的忽视或错误解读（32%）。21%的病例中存在治疗不当或管理不善的情况。