Jawad Baker Nawfal, Pedersen Kirstine Zink, Andersen Ove, Meier Ninna
Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, 2650 Copenhagen, Denmark.
Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark.
Healthcare (Basel). 2024 Sep 13;12(18):1842. doi: 10.3390/healthcare12181842.
Modern healthcare systems are increasingly organized according to diagnosis-specific clinical pathways and treatment protocols. At the same time, the number of patients with complex problems and needs that do not fit the single-diagnosis approach is rising, contributing to a high prevalence of diagnostic errors. In this article, we focus on the risk of diagnostic errors arising from missed or incomplete diagnosis and assessment of older adult patients' care needs in the first hours of acute hospitalizations in EDs. This focus is important for improving patient safety, as clinical decisions made in EDs impact patient safety in the subsequent steps of the process, thereby potentially causing new risks to arise. Based on our discussion of clinical decision-making and diagnostic errors in the acute care context, we propose a more comprehensive interdisciplinary approach to improvements in patient safety that integrates organizational and clinical research and examines where, when, how, and why risks to patient safety arise in and across different clinical-organizational contexts.
现代医疗保健系统越来越多地按照针对特定诊断的临床路径和治疗方案进行组织。与此同时,存在复杂问题和需求、不适合单一诊断方法的患者数量正在增加,这导致诊断错误的发生率很高。在本文中,我们关注在急诊科急性住院的最初几个小时内,因遗漏或未完整诊断及评估老年患者的护理需求而产生诊断错误的风险。这一关注点对于提高患者安全很重要,因为在急诊科做出的临床决策会影响后续流程中的患者安全,从而可能引发新的风险。基于我们对急性护理环境中临床决策和诊断错误的讨论,我们提出一种更全面的跨学科方法来提高患者安全,该方法整合了组织和临床研究,并审视在不同临床组织环境中以及跨这些环境,患者安全风险在何处、何时、如何以及为何出现。