Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota.
From the Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota.
J Patient Saf. 2022 Mar 1;18(2):e454-e462. doi: 10.1097/PTS.0000000000000840.
This study aimed to explore clinicians' perceptions of the occurrence of and factors associated with diagnostic errors in patients evaluated during a rapid response team (RRT) activation or unplanned admission to the intensive care unit (ICU).
A multicenter prospective survey study was conducted among multiprofessional clinicians involved in the care of patients with RRT activations and/or unplanned ICU admissions (UIAs) at 2 academic hospitals and 1 community-based hospital between April 2019 and March 2020. A study investigator screened eligible patients every day. Within 24 hours of the event, a research coordinator administered the survey to clinicians, who were asked the following: whether diagnostic errors contributed to the reason for RRT/UIA, whether any new diagnosis was made after RRT/UIA, if there were any failures to communicate the diagnosis, and if involvement of specialists earlier would have benefited that patient. Patient clinical data were extracted from the electronic health record.
A total of 1815 patients experienced RRT activations, and 1024 patients experienced UIA. Clinicians reported that 18.2% (95/522) of patients experienced diagnostic errors, 8.0% (42/522) experienced a failure of communication, and 16.7% (87/522) may have benefitted from earlier involvement of specialists. Compared with academic settings, clinicians in the community hospital were less likely to report diagnostic errors (7.0% versus 22.8%, P = 0.002).
Clinicians report a high rate of diagnostic errors in patients they evaluate during RRT or UIAs.
本研究旨在探讨临床医生对快速反应团队（RRT）激活或计划外转入重症监护病房（ICU）患者诊断错误的发生和相关因素的看法。
2019 年 4 月至 2020 年 3 月，在 2 所学术医院和 1 所社区医院，对参与 RRT 激活和/或计划外 ICU 入院（UIAs）患者护理的多专业临床医生进行了一项多中心前瞻性调查研究。一名研究调查员每天筛查符合条件的患者。在事件发生后 24 小时内，研究协调员向临床医生发放调查问卷，询问他们以下问题：诊断错误是否导致了 RRT/UIA 的原因，RRT/UIA 后是否做出了新的诊断，是否存在诊断沟通失败的情况，以及更早地让专家参与是否会使该患者受益。患者的临床数据从电子健康记录中提取。
共有 1815 名患者经历了 RRT 激活，1024 名患者经历了 UIA。临床医生报告称，18.2%（95/522）的患者发生了诊断错误，8.0%（42/522）发生了诊断沟通失败，16.7%（87/522）可能受益于更早地让专家参与。与学术环境相比，社区医院的临床医生报告诊断错误的可能性较小（7.0%比 22.8%，P=0.002）。
临床医生报告称，在他们评估 RRT 或 UIAs 期间的患者中，诊断错误的发生率很高。
