In recent years, advocacy groups, researchers, healthcare providers, and others have raised awareness and understanding about diagnostic errors, drawing attention to the profound effect that these mistakes have on patients, families, and clinicians.

The efforts to shed light on delayed, wrong, 漏诊引起了人们对这些医疗差错的范围和影响的明确关注. 不清楚的是如何解决这些问题并制定有效可行的解决方案. A number of potential strategies have been proposed, including implementing techniques to improve teamwork, 采用不断发展的技术(如人工智能和临床决策支持系统), adjusting processes and workflows, using diagnostic pathways, and exploring cognitive debiasing techniques.

美国国家科学院、工程院和医学院(NASEM)的一份有影响力的报告 Improving Diagnosis in Health Care 非常重视促进更好的团队合作，以加强诊断过程. This recommendation includes supporting an environment that is conducive to collaboration, providing technology that assists with communication, establishing measurable processes and feedback mechanisms, and engaging patients and their families in the diagnostic process.²

When Improving Diagnosis in Health Care was published in 2015, 将团队合作作为诊断过程的一部分代表了一个重大的概念转变，因为它提倡将诊断责任分配给多个提供者，而不是将责任单独放在治疗的临床医生身上——这是数百年来的标准模式. To this end, NASEM noted that the diagnostic team must have the knowledge, skills, resources, and competency to support the diagnostic process, 哪些医疗保健组织应该通过专业间和专业内的团队合作和协作来促进.⁴

Since the publication of Improving Diagnosis in Health Care, 医学界的许多其他专家和研究人员都支持以团队为基础的诊断方法. For example the National Quality Forum’s 2020 report 提高诊断质量和安全性/减少诊断错误:测量考虑 建议加强团队合作，改善团队沟通，作为与诊断错误相关的众多问题的潜在解决方案.⁵ Similarly, the 2022 Safer Dx Checklist emphasizes collaboration, clear communication, and systems/processes that support the diagnostic team.⁶

Although the concept of the diagnostic team is seemingly straightforward, its execution in various care settings is much more complex. 为了帮助医疗保健提供者和组织实现诊断团队的概念, various best practices and recommendations have been suggested. At a high level, these recommendations include:

• 将与团队模式和有效协作有关的教育和培训纳入本科和研究生医学和健康相关课程.
• 适应不断发展的劳动力队伍，其中非医生提供者-如执业护士和医师助理-越来越多地参与和领导诊断过程. 组织内的提供者和工作人员应该了解每个临床医生的执业范围，并意识到不同团队成员的角色和责任.
• Integrating allied healthcare professionals — such as pharmacists, medical technologists, physical and occupational therapists, etc. — into the diagnostic team in appropriate circumstances.
• Creating mechanisms to expand access to clinicians with specialized experience (e.g., increased consultations, telemedicine, and hotlines).
• Creating a psychologically safe culture 这促进了协作，并鼓励诊断团队成员参与并提供反馈. For example, team members should feel comfortable asking questions, making suggestions, and offering alternative hypotheses.
• Determining best practices and setting expectations for various types of communication, such as documentation in electronic health records, handoff procedures, and referrals/consultations. 在建立这些协议的过程中包括团队成员可以帮助促进意识和支持.
• 建立内部和外部反馈循环和机制，使诊断小组成员能够跟进患者随后的诊断和治疗相关结果(例如.g., between the emergency department and inpatient units/wards).
• Using collaborative care rounds, staff huddles, 暂停时间，以促进临床学科之间的交流，并审查患者的评估, working diagnoses, differential diagnoses, and care plans.
• Promoting continuing education that enhances leadership skills, soft skills (e.g.(沟通，积极倾听和情商)，以及多学科的团队合作.
• Seeking internal and external feedback on performance, including constructive criticism from members of the diagnostic team, others within the healthcare organization, patients, and other providers who are involved in patients’ care.
• Communicating verbally, rather than electronically, with clinicians and professionals in diagnostic support services, such as laboratory and radiology professionals.
• Consulting directly with pathologists about test selection and results interpretation, and seeking/providing feedback regarding testing and errors.
• 通过各种参与策略将患者/家庭作为诊断团队的一部分，帮助他们进行教育和授权. To learn more, see MedPro’s Risk Tips: Engaging Patients to Improve Diagnosis.⁷

Using a team approach to improve quality and safety in healthcare is not a new concept, 但是，使用这种模式来指导诊断过程，与几个世纪以来由治疗提供者作为单独诊断医生的规范有所不同. Yet, in recent years, 团队合作已被确定为提高诊断质量和准确性的重要策略. To adopt a diagnostic team model, 医疗保健组织可以实施一系列战略来增强组织安全文化, collaboration, communication, awareness, education, and patient engagement. 要了解有关改进诊断的更多信息，并获取临床医生和患者使用的工具，请访问 Society to Improve Diagnosis in Medicine.

Endnotes

¹ The Society to Improve Diagnosis in Medicine. (n.d.). Frequently asked questions. Retrieved from www.improvediagnosis.org/page/Facts; The Society to Improve Diagnosis in Medicine. (n.d.). What is diagnostic error? Retrieved from http://www.improvediagnosis.org/what-is-diagnostic-error/; MedPro Group. (2021). Claims data snapshot: A 10-year overview of medical cases. Retrieved from www.medpro.com/documents/10502/5086245/Claims+Data+Snapshot_Ten+Year+Overview_2010-2019_Data+Analysis.pdf

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

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 National Academies of Sciences, Engineering, and Medicine, Improving diagnosis in health care.

⁵ 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_Report.aspx

⁶ Center for Innovation in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, & Baylor College of Medicine. (2022). Improving Dx checklist: 10 high-priority practices for diagnostic excellence. 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., Improving Dx checklist: 10 high-priority practices for diagnostic excellence; Health Research & Educational Trust. (2018). Improving diagnosis in medicine change package. 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). 提高诊断能力:保健教育和培训的跨专业框架. 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). Teamwork in clinical reasoning – cooperative or parallel play? Diagnosis, 7(3), 307-312. doi: http://doi.org/10.1515/dx-2020-0020

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