Systems engineering analysis of diagnostic referral closed-loop processes

作者：Nicole Nehls, Tze Sheng Yap, Talya Salant, Mark D. Aronson, Gordon D. Schiff, Suzanne M. Olbricht, S. Akshay Navaneeth Reddy, Scot B. Sternberg, Timothy S. Anderson, Russell S. Phillips, James C. Benneyan · 发表于：BMJ Open Quality · 年份：2021 · DOI：10.1136/bmjoq-2021-001603 · 被引用次数：18 · 研究领域：Clinical Reasoning and Diagnostic Skills、Patient Safety and Medication Errors、Healthcare Systems and Technology

BACKGROUND: Closing loops to complete diagnostic referrals remains a significant patient safety problem in most health systems, with 65%-73% failure rates and significant delays common despite years of improvement efforts, suggesting new approaches may be useful. Systems engineering (SE) methods increasingly are advocated in healthcare for their value in studying and redesigning complex processes. OBJECTIVE: Conduct a formative SE analysis of process logic, variation, reliability and failures for completing diagnostic referrals originating in two primary care practices serving different demographics, using dermatology as an illustrating use case. METHODS: An interdisciplinary team of clinicians, systems engineers, quality improvement specialists, and patient representatives collaborated to understand processes of initiating and completing diagnostic referrals. Cross-functional process maps were developed through iterative group interviews with an urban community-based health centre and a teaching practice within a large academic medical centre. Results were used to conduct an engineering process analysis, assess variation within and between practices, and identify common failure modes and potential solutions. RESULTS: Processes to complete diagnostic referrals involve many sub-standard design constructs, with significant workflow variation between and within practices, statistical instability and special cause variation in completion rates and timeliness, and only 21% of all ...