System-Related Factors Contributing to Diagnostic Errors

Thammasitboon, Satid; Thammasitboon, Supat; Singhal, Geeta

doi:10.1016/j.cppeds.2013.07.004

Cited by 13 publications

(4 citation statements)

References 26 publications

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“…Recent efforts to standardise handoffs have been shown to decrease patient harm 29. Use of consultants and failure of test acquisition and follow-up have been described as risk factors contributing to DxEs 30. Additionally, in a national survey study of self-reported DxEs, hypothesis generation and a delay in considering the correct diagnosis were the largest contributors to errors related to clinical assessment 31.…”

Section: Discussionmentioning

confidence: 99%

Use of e-triggers to identify diagnostic errors in the paediatric ED

et al. 2022

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BackgroundDiagnostic errors (DxEs) are an understudied source of patient harm in children rarely captured in current adverse event reporting systems. Applying electronic triggers (e-triggers) to electronic health records shows promise in identifying DxEs but has not been used in the emergency department (ED) setting.ObjectivesTo assess the performance of an e-trigger and subsequent manual screening for identifying probable DxEs among children with unplanned admission following a prior ED visit and to compare performance to existing incident reporting systems.Design/methodsRetrospective single-centre cohort study of children ages 0–22 admitted within 14 days of a previous ED visit between 1 January 2018 and 31 December 2019. Subjects were identified by e-trigger, screened to identify cases where index visit and hospital discharge diagnoses were potentially related but pathophysiologically distinct, and then these screened-in cases were reviewed for DxE using the SaferDx Instrument. Cases of DxE identified by e-trigger were cross-referenced against existing institutional incident reporting systems.ResultsAn e-trigger identified 1915 unplanned admissions (7.7% of 24 849 total admissions) with a preceding index visit. 453 (23.7%) were screened in and underwent review using SaferDx. 92 cases were classified as likely DxEs, representing 0.4% of all hospital admissions, 4.8% among those selected by e-trigger and 20.3% among those screened in for review. Half of cases were reviewed by two reviewers using SaferDx with substantial inter-rater reliability (Cohen’s κ=0.65 (95% CI 0.54 to 0.75)). Six (6.5%) cases had been reported elsewhere: two to the hospital’s incident reporting system and five to the ED case review team (one reported to both).ConclusionAn e-trigger coupled with manual screening enriched a cohort of patients at risk for DxEs. Fewer than 10% of DxEs were identified through existing surveillance systems, suggesting that they miss a large proportion of DxEs. Further study is required to identify specific clinical presentations at risk of DxEs.

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Section: Discussionmentioning

confidence: 99%

Use of e-triggers to identify diagnostic errors in the paediatric ED

et al. 2022

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“…40 Likewise, the coexistence of system failures and cognitive errors contributing to diagnostic errors have been described, and the informed patient as source for reducing diagnostic errors has been highlighted. 42 Hence, training in communication seems even more important. The skill of doctor-patient communication might reduce the risk of decreasing patient satisfaction by sharing uncertainties in a calm, reassuring, empathic, untroubled appearing manner.…”

Section: Discussionmentioning

confidence: 99%

Bridging the Gap Between Competencies and Uncertainties in Postgraduate Training in Family Medicine: Results and Psychometric Properties of a Self-Assessment Questionnaire

Flägel¹,

Müller²,

Goetz³

et al. 2022

AMEP

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One of the reasons for postgraduate trainees not to choose working in a rural area is uncertainty related to the lack of competencies. The aim of this study was to investigate the concept of uncertainty by measuring competencies and to examine the psychometric properties of an instrument that measures competencies related to uncertainty in the self-assessment of postgraduate trainees in family medicine. Patients and Methods: A questionnaire was created based on pre-existing instruments. It was distributed to participants of postgraduate training seminars in the federal states of Baden-Württemberg and Schleswig-Holstein, Germany in 2016. Descriptive statistics and a partial correlation analysis were calculated for measuring the degree of association between year of postgraduate training and items' responses. Psychometric properties were assessed by calculating descriptive item analysis, factor analysis and internal consistency. Results: The response rate was 85% (105/124). More than one-fifth of the participants stated to show only seldom or sometimes the following skills: ability to balance work and life (N=25, 24%), letting a mild disorder run its own way (N=24, 23%) and ability to conduct interventions that decreased aggression from the patient (N=22, 21%). More than half of the participants felt (very) insecure in performing routine child check-ups, the application of a below elbow backslab and the partial removal of a toenail. Nine out of 21 items showed positive statistically significant correlation between level of competence and progress in training. Factor analysis led to a final instrument with 12 items (Cronbach's α=0.736) and a three-factor-structure: "doctor well-being and resilience", "communication" and "skills". Conclusion:In order to reduce uncertainty with all its consequences, a focus on teaching of competencies regarding the physicians' well-being and resilience, communication and skills has to be continued in postgraduate training.

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“…20 Diagnostic errors are sometimes thought of as individual cognitive errors despite a growing body of evidence that, like other types of medical errors, they are usually multifactorial and the result of a combination of environmental, system, and cognitive factors. [21][22][23] Early in the course of this study, our team identified the importance of cultivating a safe reporting culture. As previously stated, we reframed suspected diagnostic errors as learning opportunities to emphasize the goals of this project and to avoid language that could be perceived as threatening.…”

Section: Psychological Safetymentioning

confidence: 99%

Increasing Physician Reporting of Diagnostic Learning Opportunities

Marshall

Ipsaro²,

Le³

et al. 2021

Pediatrics

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BACKGROUND: An estimated 10% of Americans experience a diagnostic error annually, yet little is known about pediatric diagnostic errors. Physician reporting is a promising method for identifying diagnostic errors. However, our pediatric hospital medicine (PHM) division had only 1 diagnostic-related safety report in the preceding 4 years. We aimed to improve attending physician reporting of suspected diagnostic errors from 0 to 2 per 100 PHM patient admissions within 6 months. METHODS: Our improvement team used the Model for Improvement, targeting the PHM service. To promote a safe reporting culture, we used the term diagnostic learning opportunity (DLO) rather than diagnostic error, defined as a “potential opportunity to make a better or more timely diagnosis.” We developed an electronic reporting form and encouraged its use through reminders, scheduled reflection time, and monthly progress reports. The outcome measure, the number of DLO reports per 100 patient admissions, was tracked on an annotated control chart to assess the effect of our interventions over time. We evaluated DLOs using a formal 2-reviewer process. RESULTS: Over the course of 13 weeks, there was an increase in the number of reports filed from 0 to 1.6 per 100 patient admissions, which met special cause variation, and was subsequently sustained. Most events (66%) were true diagnostic errors and were found to be multifactorial after formal review. CONCLUSIONS: We used quality improvement methodology, focusing on psychological safety, to increase physician reporting of DLOs. This growing data set has generated nuanced learnings that will guide future improvement work.

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System-Related Factors Contributing to Diagnostic Errors

Cited by 13 publications

References 26 publications

Use of e-triggers to identify diagnostic errors in the paediatric ED

Use of e-triggers to identify diagnostic errors in the paediatric ED

Bridging the Gap Between Competencies and Uncertainties in Postgraduate Training in Family Medicine: Results and Psychometric Properties of a Self-Assessment Questionnaire

Increasing Physician Reporting of Diagnostic Learning Opportunities

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