Accuracy of the Safer Dx Instrument to Identify Diagnostic Errors in Primary Care

Al-Mutairi, Aymer; Meyer, Ashley N. D.; Thomas, Eric J.; Etchegaray, Jason Michel; Roy, Kevin; Davalos, Maria Caridad; Sheikh, Shazia; Singh, Hardeep

doi:10.1007/s11606-016-3601-x

Cited by 51 publications

(31 citation statements)

References 35 publications

(40 reference statements)

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“…3 96 Finding and analysing individual cases of diagnostic error through non-punitive and non-defensive discussions provide a unique opportunity to understand the problem and explore solutions. 112 To minimise hindsight bias that arises when events are reviewed retrospectively, it is helpful to play forward rather than backward to see if a different set of appropriate actions/judgement emerge. The goal is to understand why the actions (or inactions) made sense at the time, and what could be improved in the future.…”

Section: Developing Methods To Identify and Learn From Diagnostic Errorsmentioning

confidence: 99%

The global burden of diagnostic errors in primary care

et al. 2016

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Diagnosis is one of the most important tasks performed by primary care physicians. The World Health Organization (WHO) recently prioritized patient safety areas in primary care, and included diagnostic errors as a high-priority problem. In addition, a recent report from the Institute of Medicine in the USA, ‘Improving Diagnosis in Health Care’, concluded that most people will likely experience a diagnostic error in their lifetime. In this narrative review, we discuss the global significance, burden and contributory factors related to diagnostic errors in primary care. We synthesize available literature to discuss the types of presenting symptoms and conditions most commonly affected. We then summarize interventions based on available data and suggest next steps to reduce the global burden of diagnostic errors. Research suggests that we are unlikely to find a ‘magic bullet’ and confirms the need for a multifaceted approach to understand and address the many systems and cognitive issues involved in diagnostic error. Because errors involve many common conditions and are prevalent across all countries, the WHO’s leadership at a global level will be instrumental to address the problem. Based on our review, we recommend that the WHO consider bringing together primary care leaders, practicing frontline clinicians, safety experts, policymakers, the health IT community, medical education and accreditation organizations, researchers from multiple disciplines, patient advocates, and funding bodies among others, to address the many common challenges and opportunities to reduce diagnostic error. This could lead to prioritization of practice changes needed to improve primary care as well as setting research priorities for intervention development to reduce diagnostic error.

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Section: Developing Methods To Identify and Learn From Diagnostic Errorsmentioning

confidence: 99%

The global burden of diagnostic errors in primary care

et al. 2016

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“…57–59 Trigger tools use specific predetermined EHR events (eg, unplanned revisits to primary care) to ‘trigger’ medical record review by trained personnel. 60 These ‘trigger’ events can be similar to outcome events used in SPADE, but trigger tools rely on human chart review for adjudication of diagnostic errors, while SPADE combines biological plausibility with statistical analysis of large data sets to verify errors. Also, trigger tools are typically used to find individual patient errors for process analysis and remediation, while SPADE would be used to understand the overall landscape of misdiagnosis-related harms to prioritise problems for solution-making and to operationally track performance over time, including to assess impact of interventions.…”

Section: Differences Between Spade and Electronic Trigger Toolsmentioning

confidence: 99%

Symptom-Disease Pair Analysis of Diagnostic Error (SPADE): a conceptual framework and methodological approach for unearthing misdiagnosis-related harms using big data

Liberman

Newman‐Toker

2018

BMJ Qual Saf

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Background The public health burden associated with diagnostic errors is likely enormous, with some estimates suggesting millions of individuals are harmed each year in the USA, and presumably many more worldwide. According to the US National Academy of Medicine, improving diagnosis in healthcare is now considered ‘a moral, professional, and public health imperative.’ Unfortunately, well-established, valid and readily available operational measures of diagnostic performance and misdiagnosis-related harms are lacking, hampering progress. Existing methods often rely on judging errors through labour-intensive human reviews of medical records that are constrained by poor clinical documentation, low reliability and hindsight bias. Methods Key gaps in operational measurement might be filled via thoughtful statistical analysis of existing large clinical, billing, administrative claims or similar data sets. In this manuscript, we describe a method to guantify and monitor diagnostic errors using an approach we call ‘Symptom-Disease Pair Analysis of Diagnostic Error’ (SPADE). Results We first offer a conceptual framework for establishing valid symptom-disease pairs illustrated using the well-known diagnostic error dyad of dizziness-stroke. We then describe analytical methods for both look-back (casecontrol) and look-forward (cohort) measures of diagnostic error and misdiagnosis-related harms using ‘big data’. After discussing the strengths and limitations of the SPADE approach by comparing it to other strategies for detecting diagnostic errors, we identify the sources of validity and reliability that undergird our approach. Conclusion SPADE-derived metrics could eventually be used for operational diagnostic performance dashboards and national benchmarking. This approach has the potential to transform diagnostic quality and safety across a broad range of clinical problems and settings.

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“…Building on prior research and the NASEM report, Improving Diagnosis in Healthcare , we developed an approach to analyze and learn from cases of diagnostic error . For this focused study, we analyzed emergency medicine malpractice claims that closed between 2008 and 2015 at a large malpractice insurer.…”

Section: Introductionmentioning

confidence: 99%

Understanding diagnostic safety in emergency medicine: A case‐by‐case review of closed ED malpractice claims

Lemoine¹,

Dajer

Konwinski³

et al. 2018

J of Healthc Risk Manag

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The report Improving Diagnosis in Health Care calls for collaboration between professional liability insurance carriers and health care providers to identify opportunities to improve diagnostic performance. We used this collaborative approach and involved risk management/patient safety professionals and emergency medicine physician reviewers to analyze diagnosis-related emergency medicine closed claims from a large malpractice insurer. Our aim was to identify opportunities for risk reduction and to develop an approach for improving at-risk processes. Analysis of these cases revealed several missed opportunities in the diagnostic process. A collaborative approach offered greater insight into diagnosis process failures that may not have been evident if cases were reviewed in silos. Focused review findings led to a multidisciplinary improvement collaborative to develop clinical guidelines for improving at-risk practices and informed a simulation-based training initiative.

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Accuracy of the Safer Dx Instrument to Identify Diagnostic Errors in Primary Care

Cited by 51 publications

References 35 publications

The global burden of diagnostic errors in primary care

The global burden of diagnostic errors in primary care

Symptom-Disease Pair Analysis of Diagnostic Error (SPADE): a conceptual framework and methodological approach for unearthing misdiagnosis-related harms using big data

Understanding diagnostic safety in emergency medicine: A case‐by‐case review of closed ED malpractice claims

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