Measuring and Improving Diagnostic Safety in Primary Care: Addressing the “Twin” Pandemics of Diagnostic Error and Clinician Burnout

Olson, Andrew; Linzer, Mark; Schiff, Gordon D.

doi:10.1007/s11606-021-06611-0

Cited by 14 publications

(8 citation statements)

References 12 publications

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“…Completando la propuesta de las LV, recientemente se ha publicado un trabajo 39 que propone unas recomendaciones básicas para mejorar la seguridad del proceso diagnostico identificando tres áreas cruciales: reconocer los síntomas/señales de alarma importantes (banderas rojas), tener presentes los diagnósticos que no debemos perder y ser conscientes de los potenciales EEDD en el contexto clínico en el que trabajamos. En la intersección de potenciales fallos en estas tres áreas surgirían los EEDD, como se detalla en la figura 3 .…”

Section: Propuestas De Mejora Para Reducir Los Eventos Adversos Relacionados Con Errores En El Proceso Diagnósticounclassified

El error diagnóstico y sobrediagnóstico en Atención Primaria. Propuestas para la mejora de la práctica clínica en medicina de familia

2021

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Los médicos de familia atendemos una gran variedad de pacientes, con un amplio rango de complejidad, en poco tiempo y con pocos medios diagnósticos. Esta situación hace más vulnerables a los profesionales de atención primaria a los errores diagnósticos (EEDD). Por ello, un adecuado proceso de razonamiento clínico es la herramienta más potente con la que contamos para orientar con seguridad el proceso asistencial de los pacientes. El hecho de considerar estos errores como oportunidades perdidas de un diagnóstico correcto, que pueden producir daño al paciente, nos lleva como profesionales a revisar cómo mejorar dicho proceso. La revisión incluye, entre otros aspectos, identificar sesgos cognitivos, analizar las formas de organización del trabajo en los equipos de atención primaria y situaciones del contexto asistencial que pueden contribuir a dichos errores. En este artículo describimos los EEDD y sus factores causales más frecuentes en atención primaria, el impacto que tienen los fallos de los procesos cognitivos, las situaciones de sobrediagnóstico y las cascadas diagnósticas y terapéuticas asociadas a estos. Finalmente, proponemos un conjunto de herramientas para mejorar la toma de decisiones en el proceso diagnóstico en atención primaria.

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Section: Propuestas De Mejora Para Reducir Los Eventos Adversos Relacionados Con Errores En El Proceso Diagnósticounclassified

El error diagnóstico y sobrediagnóstico en Atención Primaria. Propuestas para la mejora de la práctica clínica en medicina de familia

2021

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“…Many elements of the medical culture and system contribute to permanent stress and pressure among HCPs, such as “individual blame, lack of organizational support, lack of community or family support, malignant training or work environments, perfectionism, personal coping styles […] encouragement of uncompromising standards, and promotion of prioritization of work and study over other areas of life” ( Robertson and Long, 2018 ). The subsequent distress has been increasingly studied in the scientific literature over the last 20 years because of the resulting problems of burnout and its negative impact on patient care ( Shanafelt et al, 2002 ; Thomas, 2004 ; Olson et al, 2021 ). This difficulty generally arises in the first year of training and increases during the course of the carrier and lingers ( Dyrbye et al, 2006 ).…”

Section: Introductionmentioning

confidence: 99%

Mindfulness and compassion training for health professionals: A qualitative study

Brun

Akinyemi²,

Houtin³

et al. 2023

Front. Psychol.

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BackgroundCompassion is a key component of quality care. Encouraging Health Care Professionals (HCPs) to develop a patient-centered care relationship through mindfulness and compassion training may be beneficial for both patients and HCPs.MethodWe assessed the impact of a compassion-centered mindfulness program [i.e., the Mindfulness Based (MB) CARE program] on healthcare practice conducting 10 phone interviews with HCPs who experienced the program.ResultsThe training had an overall positive impact on the HCPs ability to feel compassion toward their patients and themselves, helped them develop kindness toward themselves and their patients, and enhanced their attention to their patient’s needs and theirs. Participants were better able to accept the difficult work experiences or those their patients experienced, with more perceived equanimity and less reactivity.ConclusionProfessional mindfulness and compassion training programs could be operational levers for institutions aiming at fostering more compassionate HCPs–patients relationships.

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“…Because diagnosis often occurs in time-constrained, stressful and chaotic settings, we sought to contextualise our findings with a more complete understanding of conditions where clinicians performed their diagnostic work. 16 27 28 In addition to applying our tool to assess elements of the diagnostic process, we collected data on time physicians took for encounters as well as perceptions of time adequacy and work conditions by querying them regarding the time they felt was required for specific patient encounters. We concurrently measured these physicians’ level of stress and burnout using previously validated standardised tools.…”

Section: Introductionmentioning

confidence: 99%

“…A central challenge in improving diagnosis has been the issue of measurement: how to reliably, efficiently and effectively measure diagnosis quality 15–17. Unlike other areas of quality and safety, creating a standardised method for measuring diagnostic errors has proven challenging 18 19.…”

Section: Introductionmentioning

confidence: 99%

How does work environment relate to diagnostic quality? A prospective, mixed methods study in primary care

et al. 2023

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ObjectivesThe quest to measure and improve diagnosis has proven challenging; new approaches are needed to better understand and measure key elements of the diagnostic process in clinical encounters. The aim of this study was to develop a tool assessing key elements of the diagnostic assessment process and apply it to a series of diagnostic encounters examining clinical notes and encounters’ recorded transcripts. Additionally, we aimed to correlate and contextualise these findings with measures of encounter time and physician burnout.DesignWe audio-recorded encounters, reviewed their transcripts and associated them with their clinical notes and findings were correlated with concurrent Mini Z Worklife measures and physician burnout.SettingThree primary urgent-care settings.ParticipantsWe conducted in-depth evaluations of 28 clinical encounters delivered by seven physicians.ResultsComparing encounter transcripts with clinical notes, in 24 of 28 (86%) there was high note/transcript concordance for the diagnostic elements on our tool. Reliably included elements were red flags (92% of notes/encounters), aetiologies (88%), likelihood/uncertainties (71%) and follow-up contingencies (71%), whereas psychosocial/contextual information (35%) and mentioning common pitfalls (7%) were often missing. In 22% of encounters, follow-up contingencies were in the note, but absent from the recorded encounter. There was a trend for higher burnout scores being associated with physicians less likely to address key diagnosis items, such as psychosocial history/context.ConclusionsA new tool shows promise as a means of assessing key elements of diagnostic quality in clinical encounters. Work conditions and physician reactions appear to correlate with diagnostic behaviours. Future research should continue to assess relationships between time pressure and diagnostic quality.

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Measuring and Improving Diagnostic Safety in Primary Care: Addressing the “Twin” Pandemics of Diagnostic Error and Clinician Burnout

Cited by 14 publications

References 12 publications

El error diagnóstico y sobrediagnóstico en Atención Primaria. Propuestas para la mejora de la práctica clínica en medicina de familia

El error diagnóstico y sobrediagnóstico en Atención Primaria. Propuestas para la mejora de la práctica clínica en medicina de familia

Mindfulness and compassion training for health professionals: A qualitative study

How does work environment relate to diagnostic quality? A prospective, mixed methods study in primary care

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