Abstract
BackgroundDiagnostic error is an important error type since diagnostic adverse events are regularly judged as being preventable and the consequences are considered to be severe. Existing research often focuses on either diagnostic adverse events or on the errors in diagnostic reasoning. Whether and when an incorrect diagnostic process results in adverse outcomes has not been studied extensively. The present paper describes the design of a study that aims to study the relationship between a suboptimal diagnostic process and patient outcomes. In addition, the role of personal and circumstantial factors on the quality of the diagnostic process will be examined.Methods/DesignThe research questions were addressed using several data sources. First, the differential diagnosis was assessed concurrently to the diagnostic process. Second, the patient records of 248 patients suffering from shortness of breath were reviewed by expert internists in order to reveal suboptimal cognitive acts and (potential) consequences for the patient. The suboptimal cognitive acts were discussed with the treating physicians and classified with the taxonomy of unsafe acts. Third, workload, fatigue and work experience were measured during the physicians work. Workload and fatigue were measured during the physicians shift using the NASA tlx questionnaire on a handheld computer. Physicians participating in the study also answered questions about their work experience.DiscussionThe design used in this study provides insight into the relationship between suboptimal cognitive acts in the diagnostic process and possible consequences for the patient. Suboptimal cognitive acts in the diagnostic process and its causes can be revealed. Additional measurements of workload, fatigue and experience allow examining the influence of these factors on the diagnostic process. In conclusion, the present design provides a method with which insights in weaknesses of the diagnostic process and the effect on patient outcomes can be studied and opportunities for improvement can be obtained.
Highlights
Diagnostic error is an important error type since diagnostic adverse events are regularly judged as being preventable and the consequences are considered to be severe
The design used in this study provides insight into the relationship between suboptimal cognitive acts in the diagnostic process and possible consequences for the patient
They summarize that in perceptual specialties diagnostic errors appear in 2–5%, while in other specialties it occurs in 10–15% of the cases
Summary
Diagnostic error is an important error type since diagnostic adverse events are regularly judged as being preventable and the consequences are considered to be severe. Whether and when an incorrect diagnostic process results in adverse outcomes has not been studied extensively. From a large amount of information the physician has to select the information relevant for diagnosing the patient correctly Based on this information different diagnoses are considered, investigated and subsequently confirmed or ruled out. Sometimes, this is a relatively simple task while in other cases it is complicated and a lot of decision making skills are required. Berner & Graber (2008) [4] show that the rate of diagnostic error depends on medical specialty They summarize that in perceptual specialties (e.g. pathology and radiology) diagnostic errors appear in 2–5%, while in other specialties it occurs in 10–15% of the cases. In several post-mortem studies the percentage increases to 40% [5]
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