Glossary

D

Decision Support
Any system for advising or providing guidance about a particular clinical decision at the point of care. For example, a copy of an algorithm for antibiotic selection in patients with community acquired pneumonia would count as clinical decision support if made available at the point of care. Increasingly, decision support occurs via a computerized clinical information or order entry system. Computerized decision support includes any software employing a knowledge base designed to assist clinicians in decision making at the point of care.

Typically a decision support system responds to "triggers" or "flags"—specific diagnoses, laboratory results, medication choices, or complex combinations of such parameters—and provides information or recommendations directly relevant to a specific patient encounter. For instance, ordering an aminoglycoside for a patient with creatinine above a certain value might trigger a message suggesting a dose adjustment based on the patient’s decreased renal function.

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Diagnostic Errors
See Primer. Thousands of patients die every year due to diagnostic errors. While clinicians' cognitive biases play a role in many diagnostic errors, underlying health care system problems also contribute to missed and delayed diagnoses.

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Disclosure, Error Disclosure
See Primer. Many victims of medical errors never learn of the mistake, because the error is simply not disclosed. Physicians have traditionally shied away from discussing errors with patients, due to fear of precipitating a malpractice lawsuit and embarrassment and discomfort with the disclosure process.

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Disruptive and Unprofessional Behavior
See Primer. Popular media often depicts physicians as brilliant, intimidating, and condescending in equal measures. This stereotype, though undoubtedly dramatic and even amusing, obscures the fact that disruptive and unprofessional behavior by clinicians poses a definite threat to patient safety.

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Duty Hours
See Primer. Long and unpredictable work hours have been a staple of medical training for centuries. In 2003, the Accreditation Council for Graduate Medical Education (ACGME) implemented new rules limiting duty hours for all residents to reduce fatigue. The implementation of resident duty-hour restrictions has been controversial, as evidence regarding its impact on patient safety has been mixed.
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