Department of Diagnostic Imaging, Monash Health, Clayton, Victoria, Australia.
School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.
J Med Imaging Radiat Oncol. 2022 Mar;66(2):202-207. doi: 10.1111/1754-9485.13320. Epub 2021 Aug 31.
Errors in diagnostic radiology are not infrequent. Patient harm related to these errors is however less common and may be avoided via various preventative mechanisms within the medical system including, but not limited to, multidisciplinary meetings, second opinions, subspecialty expertise and clinician experience. Failure at a number of points in the system is often required to result in patient harm. Radiologists, and in particular departmental leaders, should proactively address the known underlying root causes of diagnostic errors and cognitive biases, ensure systems are in place to promptly discover and control unmitigated root causes as they arise and ensure an unbiased 'blameless' or 'just' culture of error investigation and proces sing including the implementation of non-punitive peer feedback and peer learning. This article provides an overview of errors in diagnostic radiology including the causes and potential ramifications and how we might reduce their frequency and impact.
诊断放射学中的错误并不少见。然而，与这些错误相关的患者伤害则较为少见，并且可以通过医疗系统中的各种预防机制来避免，包括但不限于多学科会议、第二意见、专科专业知识和临床医生经验。通常需要系统中的多个环节出现故障才会导致患者受到伤害。放射科医生，特别是部门领导，应该积极解决诊断错误和认知偏差的已知根本原因，确保建立系统以迅速发现和控制未缓解的根本原因，并确保一个无偏见的“无过失”或“公正”的错误调查和处理文化，包括实施非惩罚性的同行反馈和同行学习。本文概述了诊断放射学中的错误，包括其原因和潜在影响，以及我们如何降低其频率和影响。
