We analysed the trauma triage system at a specific level I trauma centre to assess rates of over- and undertriage and to support recommendations for system improvements. The triage process is designed to estimate the severity of patient injury and allocate resources accordingly, with potential errors of overestimation (overtriage) consuming excess resources and underestimation (undertriage) potentially leading to medical errors.We first modelled the overall trauma system using risk analysis methods to understand interdependencies among the actions of the participants. We interviewed six experienced trauma surgeons to obtain their expert opinion of the over- and undertriage rates occurring in the trauma centre. We then assessed actual over- and undertriage rates in a random sample of 86 trauma cases collected over a six-week period at the same centre. We employed Bayesian analysis to quantitatively combine the data with the prior probabilities derived from expert opinion in order to obtain posterior distributions. The results were estimates of overtriage and undertriage in 16.1 and 4.9% of patients, respectively. This Bayesian approach, which provides a quantitative assessment of the error rates using both case data and expert opinion, provides a rational means of obtaining a best estimate of the system's performance. The overall approach that we describe in this paper can be employed more widely to analyse complex health care delivery systems, with the objective of reduced errors, patient risk and excess costs.

译文

:我们在I级特定创伤中心分析了创伤分类系统,以评估过度分类和不足分类的发生率,并支持有关系统改进的建议。分诊过程旨在估计患者伤害的严重程度并相应地分配资源,高估(过度分类)的潜在错误会消耗过多的资源,而低估(过度分类)的潜在错误可能导致医疗错误。我们首先使用风险分析方法对整个创伤系统进行建模了解参与者行动之间的相互依存关系。我们采访了六名经验丰富的创伤外科医师,以获取他们对创伤中心发生过高和不足的比率的专家意见。然后,我们评估了在同一中心六周内收集的86例创伤病例的随机样本中的实际超检和未检穿率。我们使用贝叶斯分析将数据与专家意见得出的先验概率定量结合,以获取后验分布。结果分别为16.1%和4.9%的患者的超额分类和不足分类。这种贝叶斯方法可以使用案例数据和专家意见对错误率进行定量评估,它提供了一种合理的方法来获得对系统性能的最佳估计。我们在本文中描述的总体方法可以更广泛地用于分析复杂的医疗保健提供系统,以减少错误,降低患者风险和增加成本。

+1
+2
100研值 100研值 ¥99课程
检索文献一次
下载文献一次

去下载>

成功解锁2个技能,为你点赞

《SCI写作十大必备语法》
解决你的SCI语法难题!

技能熟练度+1

视频课《玩转文献检索》
让你成为检索达人!

恭喜完成新手挑战

手机微信扫一扫,添加好友领取

免费领《Endnote文献管理工具+教程》

微信扫码, 免费领取

手机登录

获取验证码
登录