Diagnostic testing errors can contribute to delays in diagnosis and to serious patient harm. Researchers analyzed 327 voluntary incident reports from one medical center in the Netherlands and found that diagnostic testing errors most commonly occurred during the pre-analytic phase (77%), and were predominantly caused by human factors (59%). The researchers found that these diagnostic testing errors contributed to a potential diagnostic error in 60% of cases.

Improving clinical reasoning is an important component of medical education. Using a medical malpractice claims database, researchers in this study reviewed 50 conditions identified 15 priority conditions that can be used to improve clinical reasoning education for general practitioners. The conditions represent common (e.g., eye infection), complex common (e.g., renal insufficiency, cardiovascular disease, cancer), and complex rare conditions (e.g., ectopic pregnancy) and often demonstrate atypical presentations or complex contextual factors important for diagnostic reasoning.

Clinical reasoning is an important component of medical education. In this study, first-year general practice residents concluded that diagnostic error cases, both with and without malpractice claim information, are equally effective for clinical reasoning education.

Diagnostic errors are common and have many contributing factors. This study analyzed more than 100 serious adverse event (SAE) reports in acute care using four investigation methods (e.g., Diagnostic Error Evaluation Research (DEER) taxonomy, Safer Dx Instrument) to identify common contributing factors. Transitions of care were particularly vulnerable to SAE, often due to incomplete communication between departments. Diagnostic errors occurred most often in the testing, assessment, and follow-up phases, with human factors as the most common contributing factor. Using multiple investigative methods supports more targeted interventions in each phase of diagnosis.

Checklists are increasingly used to support clinical and diagnostic reasoning processes. This study examined the impact of a checklist on electrocardiogram interpretation in 42 first-year general practice residents. Findings indicate that the checklist reduced the time to diagnosis but did not affect accuracy or confidence.

Peer feedback is an emerging approach to improving clinicians’ diagnostic reasoning skills. The authors outline several barriers to diagnostic performance feedback and propose solutions to improve diagnostic performance.

… by diagnostic safety experts and stakeholders. … Zwaan L, Smith KM, Giardina TD, et al. Patient generated …

Critical thinking skills can enhance diagnostic reasoning. This article discusses how deliberate reflection can improve diagnosis and how deliberate reflection can be integrated into digital decision support tools.

Enhancing clinical reasoning skills is an emerging strategy to reduce diagnostic errors. This meta-analysis of 26 studies estimated that cognitive reasoning tools can lead to small improvements in diagnostic accuracy.

Understanding human causes of diagnostic errors can lead to more specific targeted, specific recommendations and interventions. Using three classification instruments, researchers examined a series of serious adverse events related to diagnostic errors in the emergency department. Most of the human errors were based on intended actions and could be classified as mistakes or violations. Errors were more frequently made during the assessment and testing phases of the diagnostic process.

Diagnostic calibration is the relationship between individual confidence in diagnostic decision making and diagnostic accuracy, and it can lead to diagnostic error or overtesting. This study investigated whether feedback would improve general-practice residents’ diagnostic calibration on difficult cases. Results did not show that feedback on diagnostic performance improved diagnostic calibration.

Receiving feedback from colleagues may improve clinicians’ diagnostic reasoning skills. By building on existing models such as Safer Dx, and collaborating with professionals outside of the healthcare field, researchers developed the Diagnosis Learning Cycle, a model intended to improve diagnosis through peer feedback.

… could contribute to improved patient safety. … van Heesch G, Frenkel J, Kollen W, et al. Improving handoff by …

Reducing harm related to diagnostic error remains a major focus within patient safety. Based on input from an international group of experts and stakeholders, the authors identified priority questions to advance diagnostic safety research. High-priority areas include strengthening teamwork factors (such as the role of nurses in diagnosis), addressing system factors, and strategies for engaging patients in the diagnostic process.

… regardless of the type of reflection used.    … Mamede S, Hautz WE, Berendonk C, et al. Think twice: effects …

… accuracy between immunized and non-immunized physicians. … Mamede S, de Carvalho-Filho MA, de Faria RMD, et al.  … ' … Immunising' …

In this educational study, internal medicine resident physicians were randomized to solve standardized cases with and without time pressure. The time-pressured group performed worse, and they reported more stress and generated fewer possible diagnoses.

This clinical vignette study examined the breakdowns in diagnostic thinking for 88 medical students completing 8 standardized cases. Researchers identified cognitive biases as well as lack of knowledge and skills as causes of misdiagnosis. The authors highlight the need to improve clinical reasoning in order to promote timely, accurate diagnosis.

Decision making is typically either intuitive or analytical. This commentary discusses the two types of decision making, how heuristics and cognitive biases affect diagnostic reasoning, and strategies to reduce diagnostic error.

Hospitalists have a key role in facilitating transitions and communication. This commentary discusses how hospitalists can prevent diagnostic errors and reviews opportunities for improvement, including encouraging patient involvement in their care and face-to-face team communication in difficult-to-diagnose cases.