La sicurezza del paziente pp 247-267 | Cite as
Tecnologia dell’informazione e riduzione dell’errore
Riassunto
La sanità moderna dipende enormemente dalla tecnologia e le innovazioni tecnologiche spostano continuamente i confini di ciò che può essere ottenuto con le indagini e i trattamenti. L’avvento della tomografia computerizzata, della risonanza magnetica e della tomografia a emissione di positroni consente opportunità diagnostiche senza precedenti, inimmaginabili 30 anni fa. I progressi nelle tecniche chirurgiche hanno trasformato alcune procedure. Per esempio, in precedenza, il trattamento dell’aneurisma aortico veniva condotto mediante apertura dell’addome, clampaggio e sostituzione di una sezione dell’aorta con una protesi sintetica (un tubo per sostituire e sostenere il tessuto aortico danneggiato). La riparazione a cielo aperto di un aneurisma aortico è un intervento lungo e complesso, con morbilità e mortalità elevate, e quando riesce comporta per molti pazienti un lungo e lento recupero. Grazie agli sviluppi della tecnologia e delle tecniche, questa procedura può oggi essere eseguita attraverso un approccio endovascolare minimamente invasivo, che consiste nell’inserire minuscoli strumenti nelle arterie femorali all’altezza dell’inguine, facendoli poi avanzare fino all’aorta dove viene posizionata l’endoprotesi. Nuovi progressi, come le endoprotesi fenestrate adattabili alla particolare anatomia del paziente, e l’impiego di tecniche chirurgiche robotizzate consentono anche una precisione e un controllo maggiori in un intervento che in precedenza era decisamente pericoloso, sebbene potenzialmente salvavita (Bicknell et al., 2009; Riga et al., 2009). Gli sviluppi delle tecniche chirurgiche e della tecnologia hanno cambiato radicalmente l’equilibrio tra rischi e benefici per il paziente.
Preview
Unable to display preview. Download preview PDF.
Bibliografia
- Ash JS, Berg M, Coiera E (2004) Some unintended consequences of information technology in healthcare: the nature of patient care information system-related errors. Journal of the American Medical Informatics Association, 11:104–112CrossRefPubMedGoogle Scholar
- Bainbridge L (1987) The ironies of automation. In: Rasmussen J, Duncanand K, Le Plat J (eds) New Technologies and Human Error. John Wiley & Sons, LondonGoogle Scholar
- Bates DW (2000) Using information technology to reduce rates of medication errors in hospitals.Google Scholar
- British Medical Journal, 320:788–791Google Scholar
- Bates DW, Gawande AA (2003) Improving safety with information technology. The New England Journal of Medicine, 348(25):2526CrossRefPubMedGoogle Scholar
- Bates DW, Leape LL, Cullen DJ et al (1998) Effect of computerized physician order entry and a team intervention on prevention of serious medication errors. Journal of the American Medical Association, 280(15):1311–1316CrossRefPubMedGoogle Scholar
- Bates DW, Cohen M, Leape LL et al (2001) Reducing the frequency of medication errors using information technology. Journal of the American Medical Informatics Association, 8:299–308PubMedGoogle Scholar
- Bicknell CD, Cheshire NJ, Riga CV et al (2009) Treatment of complex aneurysmal disease with fenestrated and branched stent grafts. European Journal of Vascular and Endovascular Surgery, 37(2):175–181CrossRefPubMedGoogle Scholar
- Blaya JA, Cohen T, Rodriguez P et al (2009) Personal digital assistants to collect tuberculosis bacteriology data in Peru reduce delays, errors, and workload, and are acceptable to users: cluster randomized controlled trial. International Journal of Infectious Disease, 13(3):410–418CrossRefGoogle Scholar
- Chaudhry B, Wang J, Wu S et al (2006) Systematic review: impact of health information technology on quality, efficiency, and costs of medical care. Annals of Internal Medicine, 144(10):742–752PubMedGoogle Scholar
- Dowie J (2001) Decision analysis and the evaluating of decision technologies. Quality and Safety in Health Care, 10:1–2CrossRefGoogle Scholar
- Einbinder JS, Bates DW (2007) Leveraging information technology to improve quality and safety. Yearbook of Medical Informatics, 46:22–29Google Scholar
- Evans RS, Pestonik SC, Classen DC (1998) A computer assisted management program for antibiotics and other anti-infective agents. The New England Journal of Medicine, 338:232–238CrossRefPubMedGoogle Scholar
- Garg AX, Adhikari NKJ, McDonald H et al (2005) Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review. Journal of the American Medical Association, 293(10):1223–1238CrossRefPubMedGoogle Scholar
- Garrido T, Jamieson L, Zhou Y et al (2005) Effect of electronic health records in ambulatory care: retrospective, serial, cross-sectional study. British Medical Journal, 330:581CrossRefPubMedGoogle Scholar
- Greenhalgh T, Stramer K, Bratan T et al (2008) Introduction of shared electronic records: multisite case study using diffusion of innovation theory. British Medical Journal, 337:1040–1044CrossRefGoogle Scholar
- Grove WM, Meehl PE (1996) Comparative efficiency of informal (subjective impressionistic) and formal (mechanistic, algorithmic) prediction procedures: the clinical — statistical controversy.Google Scholar
- Psychology, Public Policy and Law, 2:293–323Google Scholar
- Hastie R, Dawes RM (2001) Rational Choice in An Uncertain World. The Psychology of Judgement and Decision Making. Sage Publications, California.Google Scholar
- Hollingworth W, Devine EB, Hansen RN et al (2007) The impact of e-prescribing on prescriber and staff time in ambulatory care clinics: a time motion study. Journal of the American Medical Informatics Association, 14(6):722–730CrossRefPubMedGoogle Scholar
- Kaushal R, Shojania KG, Bates DW (2003) Effects of computerized physician order entry and clinical decision support systems on medication safety: a systematic review. Archives of Internal Medicine, 163(12):1409–1416CrossRefPubMedGoogle Scholar
- Kawamoto K, Houlihan CA, Balas EA, Lobach DF (2005) Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success. British Medical Journal, 330:765CrossRefPubMedGoogle Scholar
- Klein G (1998) Sources of Power. How People Make Decision. MIT Press, Boston.Google Scholar
- Macklis RM, Meier T, Weinhaus MS (1998) Error rates in clinical radiotherapy. Journal of Clinical Oncology, 16:551–556PubMedGoogle Scholar
- Morris AH (2002) Decision support and safety of clinical environments. Quality and Safety in Health Care, 11(1):69–75CrossRefPubMedGoogle Scholar
- Murphy MF, Staves J, Davies A et al (2009) How do we approach a major change program using the example of the development, evaluation, and implementation of an electronic transfusion management system. Transfusion, 49(5):829–837CrossRefPubMedGoogle Scholar
- Nolan TW (2000) System changes to improve patient safety. British Medical Journal, 320:771–773CrossRefPubMedGoogle Scholar
- Overhage JM, Tiernery WM, Zhou X, McDonald CJ (1997) A randomized trial of ‘corollary orders’ to prevent errors of omission. Journal of the American Medical Informatics Association, 4(5): 364–375PubMedGoogle Scholar
- Patterson ES, Cook RI, Render ML (2002) Improving patient safety by identifying side effects from introducing bar coding in medication administration. Journal of the American Medical Informatics Association, 9(5):540–553CrossRefPubMedGoogle Scholar
- Riga C V, Bicknell CD, Wallace D et al (2009) Robot-assisted antegrade in-situ fenestrated stent grafting. Cardiovascular and Interventional Radiology, 32(3):522–524CrossRefPubMedGoogle Scholar
- Schachter DL (1999) The seven sins of memory. Insights from psychology and cognitive science. American Psychologist, 54:182–203CrossRefGoogle Scholar
- Schnipper JL, Hamann C, Ndumele CD et al (2009) Effect of an electronic medication reconciliation application and process redesign on potential adverse drug events: a cluster-randomized trial. Archives of Internal Medicine, 169(8):771–780CrossRefPubMedGoogle Scholar
- van Rosse F, Maat B, Rademaker CMA et al (2009) The effect of computerized physician order entry on medication prescription errors and clinical outcome in paediatric and intensive care: a systematic review. Paediatrics, 123(4):1184–1190CrossRefGoogle Scholar
- Volpp KGM, Grande D (2003) Residents’ suggestions for reducing errors in teaching hospitals. The New England Journal of Medicine, 348(9):851CrossRefPubMedGoogle Scholar
- Wears RL, Berg M (2005) Computer technology and clinical work: still waiting for Godot. JAMA: The Journal of the American Medical Association, 293(10):1261–1263CrossRefGoogle Scholar