在医疗保健中，诊断错误是一个常见但有害且代价高昂的问题. They are estimated to affect 12 million Americans every year,1 and the National Academies of Sciences, Engineering, 《梅高美集团4858》杂志(NASEM)指出，“我们所有人在一生中都可能经历一次有意义的诊断错误.”2

Diagnostic errors also represent a significant liability burden. Malpractice cases involving diagnosis-related allegations, when compared with other types of cases, are more common, involve more severe patient harm, and result in higher indemnities.3

提高护理质量和减少与诊断相关的责任风险需要了解诊断过程，并在每个阶段确定潜在的风险领域. To do this, 专家们提倡以团队为基础的诊断方法，将患者/家庭作为护理团队的重要成员. 

让患者/家庭作为护理的合作伙伴和诊断团队的关键成员参与可能涉及重塑既定的医疗保健规范(例如.g., 作为权威的诊断专家的单独执业医师)和解决其他患者参与障碍, such as poor communication and inadequate health literacy. 以下提示4为医疗保健提供者提供了多种方法，以培养以患者为中心的护理方法，并与患者/家属合作，以获得更好的诊断和治疗结果.

1.  邀请患者/家属了解并积极参与诊断过程. For example, 清楚地解释治疗过程，鼓励患者提供有关其健康和病史的详细信息, ask questions (e.g., “What else could cause these symptoms?”), and follow up on test and laboratory results.
2.  建议患者如何成为自己病史的良好记录者，以及如何思考和讨论自己的症状.g.(频率、位置、时间、加重和减轻因素以及相关症状). The Agency for Healthcare Research & 质量(AHRQ的)工具包用于吸引患者提高诊断安全性和NASEM的改进医疗保健诊断:患者资源, Families, 和卫生保健专业人员提供了改善信息共享的有用提示. 
3. 优化与患者/家属的口头和电子沟通, and ensure that information is timely and accurate (e.g., voicemail and email responses).
4.  Make sure that patients have access to necessary systems, such as patient portals and electronic health records, 这样他们就可以查看临床记录和诊断测试的结果.
5. 认识到文化能力是以患者为中心的护理的显著特征，也是与患者/家属建立有效沟通过程的重要组成部分. 运用有助于跨文化交流的技巧和方法, such as motivational interviewing, the explanatory model, and the RESPECT model.
6. Provide information to patients in ways that they can understand, such as using visual aids, 提供通俗易懂的教材和后续指导, 并使用诸如反导法之类的技术来评估理解能力.
7. 提供对患者友好的工具来协助信息管理, encourage dialogue, and support collaborative problem-solving. 有用工具的例子包括:做好参与的准备(AHRQ), 问我3:有益健康的好问题(医疗保健改善研究所), 和患者诊断工具包(提高医学诊断协会).
8. 与患者/家属合作，发展美高美集团4688护理和治疗的共同知识和目标，并促进相互尊重和信任.
9. Reassure patients that they should be assertive about their care, raise concerns, 如果他们的症状改变或病情恶化或没有改善，请通知医生. Make sure patients know the appropriate ways to communicate (e.g.适当使用患者门户网站、社交媒体、电子邮件和电话).
10. 鼓励患者检查其健康记录的准确性和完整性，并将相关的健康记录和检测结果转交给治疗临床医生.
11. 让患者/家庭参与改善诊断的努力，并从诊断错误和险些失误中吸取教训.g., create a patient/family advisory committee).
12. 为患者/家属提供机会，就诊断过程和与其护理有关的任何问题提供反馈. 

Endnotes

1 The Society to Improve Diagnosis in Medicine. (n.d.). What is diagnostic error? Retrieved from www.improvediagnosis.org/what-is-diagnostic-error

2 National Academies of Sciences, Engineering, and Medicine. (2015). Improving diagnosis in health care. Washington, DC: The National Academies Press.

医学诊断改进协会，诊断错误是什么?

4 National Academies of Sciences, Engineering, and Medicine, Improving diagnosis in health care; 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; National Quality Forum. (2020). 提高诊断质量和安全性/减少诊断错误:测量考虑. Retrieved from www.qualityforum.org/Publications/2020/10/Reducing_Diagnostic_Error_Measurement_Considerations_-_Final_Reports.aspx; Olson, A., Rencic, J., Cosby, K., Rusz, D., Papa, F., Croskerry, P., Zierler, B., . . . Graber, M. L. (2019). 提高诊断能力:保健教育和培训的跨专业框架. Diagnosis, 6(4), 335-341; Health Research & Educational Trust. (2018). Improving diagnosis in medicine change package. Retrieved from www.improvediagnosis.org/improving-diagnosis-in-medicine-change-package/

本文件不构成法律或医疗建议，不应被解释为规则或建立护理标准. Because the facts applicable to your situation may vary, or the laws applicable in your jurisdiction may differ, 如果您对您的法律或医疗义务或权利有任何疑问，请联系您的律师或其他专业顾问, state or federal laws, contract interpretation, or other legal questions.

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