Errors In Medicine Research Articles

Diagnostic reasoning and cognitive error in emergency medicine: Implications for teaching and learning.

Accurate diagnosis in emergency medicine (EM) is high stakes and challenging. Research into physicians' clinical reasoning has been ongoing since the late 1970s. The dual-process theory has established itself as a valid model, including in EM. It is based on the distinction between two information-processing systems. System 1 rapidly generates one or more diagnostic hypotheses almost instantaneously, driven by experiential knowledge, while System 2 proceeds more slowly and analytically, applying formal rules to arrive at a final diagnosis. We reviewed the literature on dual-process theory in the fields of cognitive science, medical education and emergency medicine. The literature reflects two prominent interpretations regarding the relationship between the fast and slow phases and these interpretations carry very different implications for the training of clinical learners. One interpretation, prominent in the EM community, presents it as a "check-and-balance" framework in which most diagnostic error is caused by cognitive biases originating within System 1. As a result, EM residents are frequently advised to deploy analytical (System 2) strategies to correct such biases. However, such teaching approaches are not supported by research into the nature of diagnostic reasoning. An alternative interpretation assumes a harmonious relationship between Systems 1 and 2 in which both fast and slow processes are driven by underlying knowledge that conditions performance and the occurrence of errors. Educational strategies corresponding to this alternative have not been explored in the EM literature. In this paper, we offer proposals for improving the teaching and learning of diagnostic reasoning by EM residents.

SFBC Working Group on sources of errors in laboratory medicine: objectives and key areas of work

Laboratory medicine plays a crucial role in patient care, contributing to approximately 70% of clinical decisions. In collaboration with clinicians, laboratory medicine specialists perform analyses that are useful for diagnosis, screening and prevention. Laboratories are known for their efficiency, which is reached through a rigorous quality system. However, errors can occur, especially given the complexity of the total testing process. These errors may lead to severe consequences, such as incorrect diagnoses or delays in treatment. Errors can occur at every stage of the total testing process, those related to the pre-analytical phase being the most prevalent. To reduce medical errors related to laboratory processes, it is essential to provide training for medical and paramedical staff, optimize production automation, and leverage technological advancements. These considerations have led to the creation of a French Working Group on Sources of Errors in Laboratory Medicine, under the aegis of the French lean society of clinical chemistry and laboratory medicine (Société Française de Biologie Clinique - SFBC). The objectives of this working group are to produce an educational handbook on sources of errors in laboratory medicine, provide training for clinical chemists, and conducting applied research projects to better understand the mechanisms behind specific errors. Ultimately, the aim is to minimize errors and enhance the quality of laboratory tests.

Understanding Diagnostic Errors: AJR Podcast Series on Diagnostic Excellence and Error, Episode 2.

In this episode of the AJR Podcast Series on Diagnostic Excellence and Error, Francis Deng, MD, and David Newman-Toker, MD, PhD, discuss prevalence and harms of diagnostic error in medicine, the role and causes of error in diagnostic radiology, and disease-specific examples, including in patients with stroke presenting with dizziness.

Definitions and Measurements for Atypical Presentations at Risk for Diagnostic Errors in Internal Medicine: Protocol for a Scoping Review.

Atypical presentations have been increasingly recognized as a significant contributing factor to diagnostic errors in internal medicine. However, research to address associations between atypical presentations and diagnostic errors has not been evaluated due to the lack of widely applicable definitions and criteria for what is considered an atypical presentation. The aim of the study is to describe how atypical presentations are defined and measured in studies of diagnostic errors in internal medicine and use this new information to develop new criteria to identify atypical presentations at high risk for diagnostic errors. This study will follow an established framework for conducting scoping reviews. Inclusion criteria are developed according to the participants, concept, and context framework. This review will consider studies that fulfill all of the following criteria: include adult patients (participants); explore the association between atypical presentations and diagnostic errors using any definition, criteria, or measurement to identify atypical presentations and diagnostic errors (concept); and focus on internal medicine (context). Regarding the type of sources, this scoping review will consider quantitative, qualitative, and mixed methods study designs; systematic reviews; and opinion papers for inclusion. Case reports, case series, and conference abstracts will be excluded. The data will be extracted through MEDLINE, Web of Science, CINAHL, Embase, Cochrane Library, and Google Scholar searches. No limits will be applied to language, and papers indexed from database inception to December 31, 2023, will be included. Two independent reviewers (YH and RK) will conduct study selection and data extraction. The data extracted will include specific details about the patient characteristics (eg, age, sex, and disease), the definitions and measuring methods for atypical presentations and diagnostic errors, clinical settings (eg, department and outpatient or inpatient), type of evidence source, and the association between atypical presentations and diagnostic errors relevant to the review question. The extracted data will be presented in tabular format with descriptive statistics, allowing us to identify the key components or types of atypical presentations and develop new criteria to identify atypical presentations for future studies of diagnostic errors. Developing the new criteria will follow guidance for a basic qualitative content analysis with an inductive approach. As of January 2024, a literature search through multiple databases is ongoing. We will complete this study by December 2024. This scoping review aims to provide rigorous evidence to develop new criteria to identify atypical presentations at high risk for diagnostic errors in internal medicine. Such criteria could facilitate the development of a comprehensive conceptual model to understand the associations between atypical presentations and diagnostic errors in internal medicine. Open Science Framework; www.osf.io/27d5m. DERR1-10.2196/56933.

Learning from medical and surgical errors: a new global insight for patients safety.

Medical errors are a pressing global public health challenge today, causing a 10% annual incidence of adverse events, increased patient mortality, and incredibly high costs for healthcare systems worldwide. The Journal of Medical and Surgical Errors’ mission is to recognize, report, and discuss errors through a multidisciplinary approach in order to both minimize error recurrence and enhance patient safety. By investigating the factors influencing error recurrences and effective preventive strategies, we aim to contribute to the reduction of preventable medical errors. Our role extends beyond mere publications; it is a commitment to transformative change in the approach to errors in healthcare. We invite researchers to contribute to building a comprehensive body of knowledge that advances our understanding of errors in medicine and surgery. Together, let us shape a future where transparency, learning, and patient safety are paramount in medical practice.

'It's a job to be done'. Managing polypharmacy at home: A qualitative interview study exploring the experiences of older people living with frailty.

Many older people live with both multiple long-term conditions and frailty; thus, they manage complex medicines regimens and are at heightened risk of the consequences of medicines errors. Research to enhance how people manage medicines has focused on adherence to regimens rather than on the wider skills necessary to safely manage medicines, and the older population living with frailty and managing multiple medicines at home has been under-explored. This study, therefore, examines in depth how older people with mild to moderate frailty manage their polypharmacy regimens at home. Between June 2021 and February 2022, 32 patients aged 65 years or older with mild or moderate frailty and taking five or more medicines were recruited from 10 medical practices in the North of England, United Kingdom, and the CARE 75+ research cohort. Semi-structured interviews were conducted face to face, by telephone or online. The interviews were recorded, transcribed verbatim and analysed using reflexive thematic analysis. Five themes were developed: (1) Managing many medicines is a skilled job I didn't apply for; (2) Medicines keep me going, but what happened to my life?; (3) Managing medicines in an unclear system; (4) Support with medicines that makes my work easier; and (5) My medicines are familiar to me-there is nothing else I need (or want) to know. While navigating fragmented care, patients were expected to fit new medicines routines into their lives and keep on top of their medicines supply. Sometimes, they felt let down by a system that created new obstacles instead of supporting their complex daily work. Frail older patients, who are at heightened risk of the impact of medicines errors, are expected to perform complex work to safely self-manage multiple medicines at home. Such a workload needs to be acknowledged, and more needs to be done to prepare people in order to avoid harm from medicines. An older person managing multiple medicines at home was a core member of the research team. An advisory group of older patients and family members advised the study and was involved in the first stages of data analysis. This influenced how data were coded and themes shaped.

Insights into diagnostic errors in endocrinology: a prospective, case-based, international study

BackgroundDiagnostic errors in internal medicine are common. While cognitive errors have previously been identified to be the most common contributor to errors, very little is known about errors in specific fields of internal medicine such as endocrinology. This prospective, multicenter study focused on better understanding the causes of diagnostic errors made by general practitioners and internal specialists in the area of endocrinology.MethodsFrom August 2019 until January 2020, 24 physicians completed five endocrine cases on an online platform that simulated the diagnostic process. After each case, the participants had to state and explain why they chose their assumed diagnosis. The data gathering process as well as the participants’ explanations were quantitatively and qualitatively analyzed to determine the causes of the errors. The diagnostic processes in correctly and incorrectly solved cases were compared.ResultsSeven different causes of diagnostic error were identified, the most frequent being misidentification (mistaking one diagnosis with a related one or with more frequent and similar diseases) in 23% of the cases. Other causes were faulty context generation (21%) and premature closure (17%). The diagnostic confidence did not differ between correctly and incorrectly solved cases (median 8 out of 10, p = 0.24). However, in incorrectly solved cases, physicians spent less time on the technical findings (such as lab results, imaging) (median 250 s versus 199 s, p < 0.049).ConclusionsThe causes for errors in endocrine case scenarios are similar to the causes in other fields of internal medicine. Spending more time on technical findings might prevent misdiagnoses in everyday clinical practice.

Clinical progress note: Diagnostic error in hospital medicine.

Clinical progress note: Diagnostic error in hospital medicine.

Common contributing factors of diagnostic error: A retrospective analysis of 109 serious adverse event reports from Dutch hospitals

IntroductionAlthough diagnostic errors have gained renewed focus within the patient safety domain, measuring them remains a challenge. They are often measured using methods that lack information on decision-making processes given...

Optimizing measurement of misdiagnosis-related harms using symptom-disease pair analysis of diagnostic error (SPADE): comparison groups to maximize SPADE validity.

Diagnostic errors in medicine represent a significant public health problem but continue to be challenging to measure accurately, reliably, and efficiently. The recently developed Symptom-Disease Pair Analysis of Diagnostic Error (SPADE) approach measures misdiagnosis related harms using electronic health records or administrative claims data. The approach is clinically valid, methodologically sound, statistically robust, and operationally viable without the requirement for manual chart review. This paper clarifies aspects of the SPADE analysis to assure that researchers apply this method to yield valid results with a particular emphasis on defining appropriate comparator groups and analytical strategies for balancing differences between these groups. We discuss four distinct types of comparators (intra-group and inter-group for both look-back and look-forward analyses), detailing the rationale for choosing one over the other and inferences that can be drawn from these comparative analyses. Our aim is that these additional analytical practices will improve the validity of SPADE and related approaches to quantify diagnostic error in medicine.

Analysis of 10 years of medical errors investigated by the Poznan University Forensic Medicine Department

At the turn of 2005 and 2006, Polish emergency medical service underwent profound changes. Emergency medical service teams (EMS) were divided into P-type, which included only paramedics, and S-type, which consisted of paramedics and a physician (Statue from 8th September 2006 about State Medical Rescue). This study aimed to determine which elements of the medical rescue system in Poland most often occurred, what kind of errors they were, and how often they resulted in a patient's death. This article analyzed 147 opinions issued by the Forensic Medicine Department at Poznań University of Medical Sciences in 2005-2015 that concerned medical errors in emergency medicine commissioned by judicial authorities from all over Poland. The study excluded opinions on the areas covered by the jurisdiction of the Appellate Prosecutor's Office in Poznań and the District Prosecutor's Office in Ostrów Wlkp., which is about 85% of the country's territory. The results of the analyses identified the Hospital Emergency Departments as the place where the most significant number of errors of all types had been committed, which were not particularly surprising. The results concerning mistakes made by the EMS teams seemed much more significant. They showed that errors in the P-type ambulances (i.e., without a doctor in the rescue team) had occurred much more often, including those resulting in the patient's death. It can therefore be concluded that the higher level of preparation of the emergency medical team members translates into a higher level of patient safety. However, some scientific reports indicate that this does not have to be the case. The most significant limitation of this study lies in the source of the analyzed data. Opinions of the Department of Forensic Medicine in Poznań in cases concerning errors in emergency medicine reflect only a tiny percentage of medical errors.

The Hawthorne Effect: Quality and Outcomes in Neurosurgery.

Measure something, and it gets better-this is what is called as the Hawthorne effect (also known as the observer effect). The Hawthorne factory experiments in 1920s were remarkable industrial data collection and analysis exercises that lead to Edwards Deming's quality revolution. The Harvard Medical Practice Study (1991), Leape's "Error in Medicine" (1994), and the Bristol pediatric cardiac report (2001) are among many documents that have revealed the huge gap between best practices and actual medical practice. Alarmed by the poor standards of quality at the most respected institutions, the medical fraternity therefore began visiting facilities in different fields and observing their quality assessment processes. The next leap for neurosurgery is to realize that it is unacceptable to treat patients with no regard for the standard of clinical outcomes. The traditional neurosurgery residency training has long ignored the most important issues of self-assessment, reappraisal, relearning, and measurement of skill and surgical outcomes. However, the experience taken from disparate fields, especially cardiac surgery, may encourage research and progress in measurement and improvement of quality in neurosurgery. Like cardiac surgeons, neurosurgeons must examine and analyze the results of their interventions. The concept of quality measurement is the most important single advance we can make in neurosurgery practice. Meticulous and precise measurement of outcomes will allow future progress of our specialty.

Error analysis in big data analysis

Practice errors in medicine are among the situations that disrupt patient-physician communication, reduce work efficiency, and eventually lead to the formation of an atmosphere of distrust. Various aspects of the subject have been examined in the symposiums we have held with Prof Dr. Ethem Geçim for 14 years. We shared our information at medikolegalduzlem.com. Big Data analysis is important in system audits. It is inevitable to reach erroneous results if the data belonging to these are made carelessly and negligently. The main problems encountered in big data analysis are: 1. Dependency: Computer dependency is at the forefront of algorithm and process monitoring. 2. Chaotic situation: The problem of systematic change is observed in the supervised learning machine. In the unsupervised learning machine, the definition of the identity of grouping is problematic. In the learning machine system of the reward-punishment system, there is a case study based on random data, not systematic. It is very difficult to reach an inductive conclusion from this situation. There is absolutely a need to organize a constant, standard data flow. 3. Loss of control: Steps that need to be checked are skipped in big data monitoring. Injustice occurs. 4. Waiver of rights: The expert is content with the data given by the machine as a dependent. There is a problem with the development of innovative processes. In that case, it is useful to pay attention to the following points in the regulation on data ethics: 1. Identity: In the big data analysis of the expert, it is important to classify and group the personal data and to accept it in court. In this respect, it is necessary to control whether the expert is legitimate, sufficient, and effective. 2. Confidentiality: The problem of privacy of the person being examined is important. The approach of the telemedicine application, which we call image-based analysis, to this problem is subject to legal and ethical evaluation. 3. Ownership: There are inadequacies in the regulation of the infrastructure applied in the field of health. The purchase of each tool and its accessible application also needs regulation. 4. Reputation: Audit problematic of non-standard practices of practitioners is evident. As a result, there is a need to evaluate error definition, error measurement, error effect, and error tolerability in big data analysis.

Diagnosis of severe anaemia and positive antibody screening as consequences of pre-analytical error.

The pre-analytical phase is the principal source of errors in laboratory medicine and continues to pose a challenge to laboratory professionals. We present the case of a 73-yearold female patient with a very low hemoglobin level (69 g/L) and positive indirect antiglobulin test result that indicates the key role of phlebotomy as an important error-prone process in which mistakes can have serious consequences for the patient's diagnosis and treatment. We conclude that there is still an urgent and continuous need to provide educational activities for healthcare professionals involved in blood collection, improve blood collection guideline adherence, and eliminate the errors which can affect diagnosis and treatment, thus jeopardising patient safety.

What is the evidence that a pharmacy team working in an acute or emergency medicine department improves outcomes for patients: A systematic review.

Pharmacy services within hospitals are changing, with more taking on medication reconciliation activities. This systematic review was conducted to determine the measured impacts of Pharmacy teams working in an acute or emergency medicine department. The protocol followed the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines and was prospectively registered on PROSPERO, National Institute for Health and Care Research, UK registration number: CRD42020187487. The systematic review had two co‐primary aims: a reduction in the number of incorrect prescriptions on admission by comparing the medication list from primary care to secondary care, and a reduction in the severity of harm caused by these incorrect prescriptions; chosen to determine the impact of pharmacy‐led medication reconciliation services in the emergency and acute medicine setting. Seventeen articles were included. Fifteen were non‐randomized controlled trials and two were randomized controlled trials. The number of patients combined for all studies was 7630. No studies included were based within the UK. All studies showed benefits in terms of a reduction in medicine errors and patient harm, compared to control arms. Nine articles were included in a statistical analysis comparing the pharmacy intervention arm with the non‐pharmacy control arm, with a Chi2 of 101.10 and I 2 value = 92%. However, studies were heterogenous with different outcome measures and many showed evidence of bias. The included studies consistently indicated that pharmacy services based within acute or emergency medicine departments in hospitals were associated with fewer medication errors. Further studies are needed to understand the health and economic impact of deploying a pharmacy service in acute medical settings including out‐of‐hours working.

Quality and Safety in Health Care, Part LXXXII: Introduction to High Reliability Organizations.

Reports from the Institute of Medicine regarding the number of errors in medicine leading to fatalities prompted a major review of medical practices and a move to make medical systems high reliability organizations. Many of the concepts used today to improve performance in health care are borrowed from what has been learned from successes and accidents in other industries, especially in the aviation, space, and nuclear power programs. An emphasis on excellent leadership and communication, the knowledge that there needs to be an emphasis on system failures rather than human failures, and having a safety culture that encourages everyone to be mindful of potential errors and report errors are critical to achieve high reliability.

Explaining emergency physicians’ capacity to recover from interruptions

ObjectiveTo assess whether the capacity to utilize cues amongst emergency physicians is associated with differences in the capacity to recover performance following an interruption. BackgroundInterruptions are implicated in errors in emergency medicine due to the cognitive load that they impose on working memory, resulting in a loss of performance on the primary task. The utilization of cues is associated with a reduction in cognitive load during the performance of a task, thereby enabling the allocation of residual resources that mitigates the loss of performance following interruptions. MethodThirty-nine emergency physicians, recruited at a medical conference, completed an assessment of cue utilization (EXPERTise 2.0) and an online simulation (Septris) that involved the management of patients presenting with sepsis. During the simulation, physicians were interrupted and asked to check a medication order. Task performance was assessed using scores on Septris, with points awarded for the accurate management of patients. ResultsEmergency physicians with higher cue utilization recorded significantly higher scores on the simulation task following the interruption, compared to physicians with lower cue utilization (p = .028). ConclusionThe results confirm a relationship between cue utilization and the recovery of performance following an interruption. This is likely due to the advantages afforded by associated reductions in cognitive load. ApplicationAssessments of cue utilization may assist in the development of interventions to support clinicians in interruptive environments.

PERCEPTIONS OF POSTGRADUATE STUDENTS ABOUT PATIENT SAFETY AS PART OF THE CURRICULUM AT UNDERGRADUATE AND POSTGRADUATE LEVEL

&#x0D; Objective: To explore their perception how patient safety is being addressed in undergraduate and post graduate medical curriculum&#x0D; &#x0D; Methods: This was descriptive survey; using the universal sampling technique a questionnaire based survey was conducted with 80 post graduate residentss in two selected tertiary care hospitals to determine their attitude towards the patient’s safety measures. A tested questionnaire was used to collected data. Descriptive statistics were obtained by using SPSS software version 20.&#x0D; &#x0D; Results: out of total 80 participants 16% were female and 84% were male having clinical experience ranged from 2-5 years. Regarding the attitude varying responses were reported. 17(21.3%) were strongly agreed that Making errors in medicine is inevitable, similarly 52(65%) were also strongly agreed that consciousness after encountering with error could reduce the occurrence. 29(36.3%) were strongly agreed that Competent physicians do not make medical errors, regarding morality 55(68.8%) were strongly agrees the patient safety is our moral responsibility. however they indicated that there is lack of proper reporting system which act as barrier. Less than half of the participants were in support of routinely report medical errors. 58(72.5%) reported with disagreement regarding reporting the medical error. The document review shows that there is no specific slot delegated to the patient safety measure in the curriculum of Postgraduate as well as undergraduate medical curriculum however they has addressed the topic indirectly to some extent.&#x0D; &#x0D; Conclusion: It is concluded that the participants (Trainees medical officers) had positive attitude towards the patient safety. Although they are aware about patient safety however has varying interpretations depending upon the case and situation. The medical errors being inevitable aspects is broadly associated with; the human factor, system and management factors which have further multi-facets linkages, contributing to medical error. The main reason for the patient safety concerns is due to the gap between what WHO recommended about patient safety and the curricular contents of undergraduate and postgraduate medical studies in Pakistan

Behavioral Assessment in Virtual Reality: An Evaluation of Multi-User Simulations in Healthcare Education

ABSTRACT Human error in medicine – medical error – has been identified as the third leading cause of death within the United States. Analyses of deaths attributable to medical error conclude that faulty communication plays a central role in medical error. Patient handoffs, the transfer of patient care from one medical professional to another, are frequently occurring behavioral events in healthcare settings where communication accuracy is vital. The medical industry looks to lessons learned from other highly technical, risk-inherent industries such as aviation; they have created a training package called TeamSTEPPS® to address medical error. Among such initiatives, a fundamental challenge is the objective measurement of specific, critical skills. Behavior science offers a robust history of objective behavioral measurement and assessment, and virtual reality (VR) provides a measurement-rich platform for assessing behavior in simulations. The replacement of in-person (Direct) simulations with VR lacks validation research. The present study evaluated the validity of using VR simulations in healthcare education to measure and assess critical skills identified by the TeamSTEPPS® framework for healthcare professionals during simulated patient handoffs.

Making Healthcare Safe: The Story of the Patient Safety Movement

Making Healthcare Safe: The Story of the Patient Safety Movement