O'Leary M R, Smith M S, O'Leary D S, Olmsted W W, Curtis D J, Groleau G, Mabey B
Department of Emergency Medicine, George Washington University Medical Center, Washington, DC.
JAMA. 1989;262(24):3444-7.
Clinical indicators were developed and used to assess the quality of patient care resulting from the system of shared responsibility between emergency department (ED) and radiology department faculty physicians for interpretation of ED roentgenograms. The first indicator--all discrepancies in roentgenogram interpretation between ED and radiology department faculty--measured an overall discrepancy rate of 3.3% (776 films). Three hundred fifty-two apparent discrepancies were not related to the accuracy with which ED faculty interpreted films, resulting in a revised overall discrepancy rate of 1.8%. The second indicator--undesirable patient care outcomes as a result of delayed accurate radiological diagnosis--measured an occurrence rate of 0 after clinical reevaluation of more than 99% of patients within 24 hours of initial ED evaluation. Aspects of the development and use of clinical indicators are discussed in relationship to the broader monitoring and evaluating process necessary for the continuous improvement of patient care.
制定了临床指标并用于评估急诊科（ED）与放射科教员共同负责解读ED X光片所带来的患者护理质量。第一个指标——ED与放射科教员之间X光片解读的所有差异——测得总体差异率为3.3%（776张胶片）。352处明显差异与ED教员解读胶片的准确性无关，因此修订后的总体差异率为1.8%。第二个指标——因放射学诊断延迟而导致的不良患者护理结果——在初始ED评估后24小时内对超过99%的患者进行临床重新评估后，测得发生率为0。结合持续改善患者护理所需的更广泛监测和评估过程，讨论了临床指标的制定和使用方面。
