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首页> 外文期刊>BMC Medical Informatics and Decision Making >Assessment of the potential impact of a reminder system on the reduction of diagnostic errors: a quasi-experimental study
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Assessment of the potential impact of a reminder system on the reduction of diagnostic errors: a quasi-experimental study

机译：评估提醒系统对减少诊断错误的潜在影响：一项准实验研究

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Background Computerized decision support systems (DSS) have mainly focused on improving clinicians' diagnostic accuracy in unusual and challenging cases. However, since diagnostic omission errors may predominantly result from incomplete workup in routine clinical practice, the provision of appropriate patient- and context-specific reminders may result in greater impact on patient safety. In this experimental study, a mix of easy and difficult simulated cases were used to assess the impact of a novel diagnostic reminder system (ISABEL) on the quality of clinical decisions made by various grades of clinicians during acute assessment. Methods Subjects of different grades (consultants, registrars, senior house officers and medical students), assessed a balanced set of 24 simulated cases on a trial website. Subjects recorded their clinical decisions for the cases (differential diagnosis, test-ordering and treatment), before and after system consultation. A panel of two pediatric consultants independently provided gold standard responses for each case, against which subjects' quality of decisions was measured. The primary outcome measure was change in the count of diagnostic errors of omission (DEO). A more sensitive assessment of the system's impact was achieved using specific quality scores; additional consultation time resulting from DSS use was also calculated. Results 76 subjects (18 consultants, 24 registrars, 19 senior house officers and 15 students) completed a total of 751 case episodes. The mean count of DEO fell from 5.5 to 5.0 across all subjects (repeated measures ANOVA, p Conclusion The provision of patient- and context-specific reminders has the potential to reduce diagnostic omissions across all subject grades for a range of cases. This study suggests a promising role for the use of future reminder-based DSS in the reduction of diagnostic error.
机译：背景技术计算机决策支持系统（DSS）主要致力于提高临床医生在异常和具有挑战性的情况下的诊断准确性。但是，由于诊断遗漏错误可能主要是由常规临床实践中的不完善检查导致的，因此提供适当的针对患者和特定情况的提醒可能会对患者的安全产生更大的影响。在这项实验研究中，混合使用简单和困难的模拟案例来评估新型诊断提醒系统（ISABEL）对急性评估期间各个级别的临床医生做出的临床决策质量的影响。方法不同等级的受试者（顾问，注册服务商，高级房屋官和医科学生）在试验网站上评估了24组模拟病例的平衡集。在系统咨询之前和之后，受试者记录其针对病例的临床决策（鉴别诊断，测试订购和治疗）。由两名儿科顾问组成的小组分别针对每种情况提供了黄金标准回应，以此来衡量受试者的决策质量。主要结果指标是漏诊诊断错误（DEO）计数的变化。使用特定的质量评分可以更敏感地评估系统的影响;还计算了因使用DSS而产生的额外咨询时间。结果76名受试者（18名顾问，24名注册服务商，19名高级房屋官和15名学生）共完成了751起案例。在所有受试者中，DEO的平均数从5.5下降到5.0（重复测量方差分析，p结论）提供针对患者和特定情境的提醒可能会减少一系列病例中所有受试者等级的诊断遗漏。在减少诊断错误方面使用未来基于提醒的DSS的重要作用。

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