From the Department of Radiology, Wake Forest Baptist Medical Center, Medical Center Blvd, Winston-Salem, NC 27157-1088 (J.N.I., R.R.T.); and Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Va (R.O.M., A.J.P., S.H.P.).
Radiographics. 2018 Oct;38(6):1845-1865. doi: 10.1148/rg.2018180021.
Imaging plays a pivotal role in the diagnostic process for many patients. With estimates of average diagnostic error rates ranging from 3% to 5%, there are approximately 40 million diagnostic errors involving imaging annually worldwide. The potential to improve diagnostic performance and reduce patient harm by identifying and learning from these errors is substantial. Yet these relatively high diagnostic error rates have persisted in our field despite decades of research and interventions. It may often seem as if diagnostic errors in radiology occur in a haphazard fashion. However, diagnostic problem solving in radiology is not a mysterious black box, and diagnostic errors are not random occurrences. Rather, diagnostic errors are predictable events with readily identifiable contributing factors, many of which are driven by how we think or related to the external environment. These contributing factors lead to both perceptual and interpretive errors. Identifying contributing factors is one of the keys to developing interventions that reduce or mitigate diagnostic errors. Developing a comprehensive process to identify diagnostic errors, analyze them to discover contributing factors and biases, and develop interventions based on the contributing factors is fundamental to learning from diagnostic error. Coupled with effective peer learning practices, supportive leadership, and a culture of quality, this process can unquestionably result in fewer diagnostic errors, improved patient outcomes, and increased satisfaction for all stakeholders. This article provides the foundational elements for implementing this type of process at a radiology practice, with examples to help radiologists and practice leaders achieve meaningful practice improvement. RSNA, 2018.
影像学在许多患者的诊断过程中起着关键作用。据估计，平均诊断错误率在 3%至 5%之间，全球每年约有 4000 万例涉及影像学的诊断错误。通过识别和从这些错误中学习，有很大的潜力可以提高诊断性能并减少患者伤害。尽管我们的领域已经进行了数十年的研究和干预，但这些相对较高的诊断错误率仍然存在。放射科的诊断错误似乎经常是偶然发生的，但实际上，放射科的诊断问题解决并不是一个神秘的黑盒子，诊断错误也不是随机发生的。相反，诊断错误是可以预测的事件，有明显的促成因素，其中许多因素是由我们的思维方式或与外部环境有关的因素驱动的。这些促成因素会导致感知和解释方面的错误。确定促成因素是开发可以减少或减轻诊断错误的干预措施的关键之一。制定一个全面的流程来识别诊断错误，分析错误以发现促成因素和偏差，并根据促成因素制定干预措施，对于从诊断错误中学习至关重要。再加上有效的同行学习实践、支持性的领导和质量文化，这一过程无疑可以减少诊断错误，改善患者的结果，并提高所有利益相关者的满意度。本文提供了在放射科实践中实施这种类型流程的基础要素，并提供了一些示例，以帮助放射科医生和实践领导者实现有意义的实践改进。RSNA，2018。
