Clinical reasoning is now a common method to improve diagnostic decision making, and several tools have been developed to assess learners’ clinical reasoning. In this study, hospital faculty and pediatric interns used the Assessment of Reasoning Tool (ART) to assess, teach, and guide feedback on the interns’ clinical reasoning. Faculty and interns report the ART framework was highly structured, specific, formative, and facilitated goal setting.

Patients in the neonatal intensive care unit (NICU) are at risk for serious patient safety threats. In this retrospective review of 600 consecutive inborn NICU admissions, researchers found that the frequency of diagnostic errors among inborn NICU patients during the first seven days of admission was 6.2%.

Never events can result in serious patient harm and indicate serious underlying organizational safety problems. This study analyzed never events occurring between 2012 and 2020 in the National Health Services and categorized 51 common never events into four categories – wrong site surgery (40% of events); retained foreign objects post-procedure (28%); wrong implant/prosthesis (13%); and non-surgical/infrequent never events (19%). Awareness of these themes may support focused efforts to reduce their incidence and development of specific local safety standards. 

Never events, a significant type of adverse event, should never occur in healthcare. This study analyzed 797 surgical never events that occurred from April 2012 to February 2020 in the National Health Service (NHS) England and categorized them into three main categories: wrong-site surgery (53.58%), retained items post-procedure (44.54%), and wrong implant/prosthesis (1.88%). In total 56 common general surgery never events have been found. Being aware of the common themes may help providers to develop more effective strategies to prevent these adverse events.

Over a 2-month period, researchers surveyed pediatric clinicians to asses their comfort discussing medical errors (involving both systems and individual clinician responsibility) during morbidity & mortality conferences and privately with their peers. Respondents were least comfortable publicly discussing errors and were significantly less comfortable discussing diagnostic errors compared with other medical errors. The greatest barriers to discussing errors involved public perception of clinical performance.   

This interview study examined how pediatric clinicians communicate diagnostic uncertainty to parents. Researchers found that the clinicians adjusted their explanations based on patient factors like health literacy and on the strength of the clinician–family relationship. The authors conclude that the variability in communicating diagnostic uncertainty signals a need to develop and test best practices.

Reducing diagnostic error is an area of increasing focus within patient safety. However, little is known about how patients perceive physician communication regarding diagnostic uncertainty. In this study, participants (parents of pediatric patients) were assigned to read one of three clinical vignettes each describing a different approach to a physician communicating diagnostic uncertainty; they were then asked to answer a questionnaire. Researchers found that explicit expression of diagnostic uncertainty by a physician was associated with negative perceptions of physician competence as well as diminished trust and satisfaction with care, whereas more implicit language was not. A past Annual Perspective highlighted some of the challenges associated with diagnostic error.

… the challenges associated with diagnostic error. … Davalos MC, Samuels K, Meyer AN, et al. Finding Diagnostic Errors in …

This review describes methods to address system and cognitive weaknesses in the diagnostic process.

Experienced diagnosticians rely on heuristics—rules of thumb—to recognize clinical patterns and establish diagnoses efficiently. However, this process can lead to diagnostic error, as numerous cognitive biases can adversely affect the diagnostic reasoning process. This two-part series reviews the psychological origins of cognitive biases, examines the theoretical basis behind "debiasing" approaches (strategies for averting specific cognitive biases), and proposes a framework for preventing diagnostic errors through educational and systems-based approaches. Two of the most common cognitive biases, premature closure (diagnosing a patient on the basis of preliminary or incomplete information) and anchoring (failing to reconsider a provisional diagnosis in the face of conflicting information) are vividly illustrated in an AHRQ WebM&M commentary. Dr. Pat Croskerry, the lead author of these articles, was interviewed by AHRQ WebM&M in 2010.

A considerable number of patients suffer preventable harm due to diagnostic errors every year. Our knowledge of underlying causes of missed diagnoses, and the types of diagnoses that are often missed, are largely based on autopsy studies and data from malpractice claims, which may over-represent diagnoses that cause death or serious disability. The 1300 pediatricians and pediatric trainees surveyed in this study identified misdiagnosis of viral illnesses as bacterial infections and failure to recognize medication side effects as the most common types of diagnostic error. Faulty information gathering and suboptimal communication were named as the principal individual and system factors leading to diagnostic error. Physicians named closer follow-up and reliable test management systems as major system improvements that could reduce the risk of diagnostic error.