In recent years, advocacy groups, researchers, healthcare providers, 还有一些人提高了对诊断错误的认识和理解, 让人们注意到这些错误对病人造成的深远影响, families, and clinicians.

揭示真相的努力被推迟了, wrong, and missed diagnoses have drawn clear attention to the scope and impact of these medical errors. What isn’t as clear is how to address these issues and develop effective and viable solutions. 已经提出了一些潜在的战略, 包括运用技巧来提高团队合作, adopting evolving technologies (such as artificial intelligence and clinical decision support systems), 调整流程和工作流程, 使用诊断途径, 探索认知去偏见技术.

The 国家科学院、工程院和医学院’s (NASEM’s) influential report 改善医疗保健诊断 places significant emphasis on facilitating better teamwork to strengthen the diagnostic process. 这个建议包括支持一个有利于协作的环境, 提供有助于交流的技术, 建立可测量的过程和反馈机制, 让病人和他们的家人参与到诊断过程中来.²

When 改善医疗保健诊断 was published in 2015, the focus on teamwork as part of the diagnostic process represented a major conceptual shift because it advocated for distributing diagnostic responsibility across multiple providers rather than placing responsibility solely on the treating clinician — a model that had been the standard for hundreds of years. To this end, NASEM指出，诊断团队必须具备这些知识, skills, resources, 以及支持诊断过程的能力, which healthcare organizations should facilitate through interprofessional and intraprofessional teamwork and collaboration.⁴

Since the publication of 改善医疗保健诊断, numerous other experts and researchers in the medical community have supported a team-based approach to diagnosis. 例如，国家质量论坛的2020年报告 Improving Diagnostic Quality and Safety/Reducing Diagnostic Error: Measurement Considerations recommends strengthening teamwork and improving team communication as potential solutions for numerous issues associated with diagnostic errors.⁵ Similarly, the 2022 Safer Dx Checklist 强调合作, clear communication, 以及支持诊断团队的系统/流程.⁶

虽然诊断团队的概念看起来很简单, 它在各种护理环境中的执行要复杂得多. In an effort to help healthcare providers and organizations bring the concept of the diagnostic team to fruition, 提出了各种最佳实践和建议. 在高一级，这些建议包括:

• Incorporating education and training related to team paradigms and effective collaboration into undergraduate and postgraduate medical and health-related curricula.
• Adapting to an evolving workforce in which nonphysician providers — such as nurse practitioners and physician assistants — are increasingly involved in and leading the diagnostic process. Providers and staff members within organizations should understand the scope of each clinician’s practice and be aware of various team members’ roles and responsibilities.
• 整合联合医疗保健专业人员——如药剂师, medical technologists, 物理和职业治疗师, etc. -在适当的情况下进入诊断小组.
• 建立机制，扩大获得具有专业经验的临床医生的机会(例如.g.增加咨询、远程医疗和热线)。.
• Creating a 心理安全文化 that fosters collaboration and encourages members of the diagnostic team to participate and provide feedback. For example, 团队成员应该对提问感到自在, making suggestions, 并提出不同的假设.
• 确定最佳实践并为各种类型的沟通设定期望, 例如电子健康记录中的文档, handoff procedures, 和推荐/咨询. Including team members in the process of establishing these protocols can help facilitate awareness and support.
• Creating internal and external feedback loops and mechanisms that allow members of diagnostic teams to follow up on patients’ subsequent diagnostic and treatment-related outcomes (e.g.(在急诊科和住院病房之间).
• 使用协作式护理查房, staff huddles, and timeouts to facilitate communication among clinical disciplines and to review patient assessments, working diagnoses, differential diagnoses, and care plans.
• 促进继续教育，以提高领导技能、软技能(如.g., communication, active listening, and emotional intelligence), and multidisciplinary teamwork.
• 寻求内部和外部对工作表现的反馈, 包括来自诊断团队成员的建设性批评, 医疗保健组织内的其他人, patients, 以及其他参与病人护理的提供者.
• Communicating verbally, 而不是电子方式, 与临床医生和专业人士进行诊断支持服务, 比如实验室和放射专业人员.
• 直接咨询病理学家美高美集团4688测试选择和结果解释, 寻找/提供美高美集团4688测试和错误的反馈.
• Including patients/families as part of the diagnostic team through various engagement strategies that help educate and empower them. 要了解更多信息，请参阅MedPro 's 风险提示:吸引患者提高诊断.⁷

使用团队方法来提高医疗保健的质量和安全性并不是一个新概念, but using this model to guide the diagnostic process diverges from the centuries-old norm of the treating provider as the solo diagnostician. Yet, in recent years, teamwork has been identified as a vital strategy for improving diagnostic quality and accuracy. 采用诊断团队模式, healthcare organizations can implement a range of strategies to enhance organizational safety culture, collaboration, communication, awareness, education, and patient engagement. To learn more about improving diagnosis, and to access tools for clinicians and patients, visit the 提高医学诊断的社会.

Endnotes

¹ 提高医学诊断学会. (n.d.). 常见问题. Retrieved from www.improvediagnosis.org/page/Facts; 提高医学诊断学会. (n.d.). 什么是诊断错误? Retrieved from http://www.improvediagnosis.org/what-is-diagnostic-error/; MedPro Group. (2021). 索赔数据快照:10年医疗案例概述. Retrieved from www.medpro.com/documents/10502/5086245/Claims +数据+ Snapshot_Ten + + overview_2010 - 2019年- _data +分析.pdf

² 国家科学院、工程院和医学院. (2015). 提高卫生保健诊断水平. 华盛顿特区:国家科学院出版社.

³ Graber, M., Rusz, D., Jones, M., Farm-Franks, D., Jones, B., Cyr Gluck, J., Thomas, D. B., . . . Eichbaum, Q. (2017). The new diagnostic team. Diagnosis, 4(4), 225-238.

⁴ 美国国家科学院、工程院和医学院， 提高卫生保健诊断水平.

⁵ National Quality Forum. (2020). Improving diagnostic quality and safety/reducing diagnostic error: Measurement considerations. Retrieved from www.qualityforum.org/Publications/2020/10/Reducing_Diagnostic_Error__Measurement_Considerations_-_Final_Report.aspx

⁶ 质量、有效性和安全创新中心(IQuESt)， Michael E. 德贝基退伍军人事务医疗中心， & 贝勒医学院. (2022). 改进Dx检查表:卓越诊断的10个高优先级实践. Retrieved from www.ihi.org/resources/Pages/Tools/safer-diagnostic-checklist.aspx

⁷ Graber, et al., The new diagnostic team; Center for Innovation in Quality, Effectiveness, and Safety (IQuESt), et al., 改进Dx检查表:卓越诊断的10个高优先级实践; Health Research & Educational Trust. (2018). 提高药品变更包的诊断率. Retrieved from www.improvediagnosis.org/improving-diagnosis-in-medicine-change-package/; Olson, A., Rencic, J., Cosby, K., Rusz, D., Papa, F., Croskerry, P., Zierler, B., . . . Graber, M. L. (2019). Competencies for improving diagnosis: An interprofessional framework for education and training in health care. Diagnosis, 6(4), 335-341. doi: http://doi.org/10.1515/dx-2018-0107; Olson, A., Durning, S. J., Fernandez Branson, C., Sick, B., Lane, K. P., & Rencic, J. J. (2020). 临床推理中的团队合作——合作或平行游戏? Diagnosis, 7(3), 307-312. doi: http://doi.org/10.1515/dx-2020-0020

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