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Patel SJ, Ipsaro A, Brady PW. Hosp Pediatr. 2022;Epub Feb 28.
Diagnostic uncertainty can arise in complex clinical scenarios. This qualitative study explored how physicians in pediatric emergency and inpatient settings mitigate diagnostic uncertainty. Participants discussed common mitigation strategies, such as employing a “diagnostic pause.” The authors also noted outstanding gaps regarding communicating diagnostic uncertainty to families.
Shafer GJ, Singh H, Thomas EJ, et al. J Perinatol. 2022;Epub Mar 4.
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%.
Cooper A, Carson-Stevens A, Cooke M, et al. BMC Emerg Med. 2021;21:139.
Overcrowding in the emergency department (ED) can result in increased frequency of medication errors, in-hospital cardiac arrest, and other patient safety concerns. This study examined diagnostic errors after introducing a new healthcare service model in which emergency departments are co-located with general practitioner (GP) services. Potential priority areas for improvement include appropriate triage, diagnostic test interpretation, and communication between GP and ED services.
Gibson BA, McKinnon E, Bentley RC, et al. Arch Pathol Lab Med. 2021;Epub Oct 21.
A shared understanding of terminology is critical to providing appropriate treatment and care. This study assessed pathologist and clinician agreement of commonly-used phrases used to describe diagnostic uncertainty in surgical pathology reports. Phrases with the strongest agreement in meaning were “diagnostic of” and “consistent with”. “Suspicious for” and “compatible with” had the weakest agreement. Standardized diagnostic terms may improve communication.
Kukielka E. Patient Saf. 2021;3:18-27.
Trauma patients, who often suffer multiple, severe injuries and who may arrive to the Emergency Department (ED) unconscious, are vulnerable to adverse events. Using data reported to the Pennsylvania Patient Safety Reporting System (PA-PSRS), researchers in this study evaluated the safety challenges of caring for patients presenting to the ED after a motor vehicle collision. Common challenges included issues with monitoring, treatment, evaluation, and/or documentation, patient falls, medication errors, and problems with transfers.
Hensgens RL, El Moumni M, IJpma FFA, et al. Eur J Trauma Emerg Surg. 2020;46:1367-1374.
Missed injuries and delayed diagnoses are an ongoing problem in trauma care. This cohort study conducted at a large trauma center found that inter-hospital transfer of severely injured patients increases the risk of delayed detection of injuries. For half of these patients, the new diagnoses led to a change in treatment course. These findings highlight the importance of clinician vigilance when assessing trauma patients.
Bhat A, Mahajan V, Wolfe N. J Clin Neurosci. 2021;85:27-35.
Misdiagnosis, variation in treatment of stroke and gaps in secondary prevention in young patients can result in adverse outcomes. This article discusses the possible causes of implicit bias in stroke care in this population, the effects of bias on patient outcomes, and interventions to circumvent implicit bias.  
Gleason KT, Peterson SM, Dennison Himmelfarb CR, et al. Diagnosis (Berl). 2021;8(2) :187-192.
Diagnostic error is an ongoing patient safety challenge, and can be exacerbated by the hectic pace of the emergency department (ED). This study assessed the feasibility of the Leveraging Patient’s Experience to Improve Diagnosis (LEAPED) program to measure patient-reported diagnostic error after ED discharge. Across three EDs, patient uptake of the program was high. Findings show that 23% of patients did not receive an explanation of their health problem upon discharge, and one-quarter of those patients did not understand the next steps after leaving the ED.
Liberman AL, Skillings J, Greenberg P, et al. Diagnosis (Berl). 2020;7:37-43.
Ischemic stroke, which often presents with non-specific symptoms and requires time-sensitive treatment, can be a source of diagnostic error and misdiagnosis. Using a large medical malpractice claims database, this study found that nearly half of all malpractice claims involving ischemic stroke included diagnostic errors, primarily originating in the ED. The analysis found that breakdowns in the initial patient-provider encounter (e.g., history and physical examination, symptom assessment, and ordering of diagnostic tests) contributed to most malpractice claims.
Wright B, Faulkner N, Bragge P, et al. Diagnosis (Berl). 2019;6:325-334.
The hectic pace of emergency care detracts from reliability. This review examined the literature on evidence, practice, and patient perspectives regarding diagnostic error in the emergency room. A WebM&M commentary discussed an incident involving a diagnostic delay in the emergency department.
Roland D, Snelson E. Arch Dis Child Educ Pract Ed. 2019;104:43-48.
Clinical reasoning is a complex process that can be influenced by numerous factors. This review describes factors that influence decision-making in acute pediatric care. The authors discuss difficulty in history taking, biases, and other elements that can degrade the patient assessment required to inform appropriate diagnosis and treatment.
Lawton R, Robinson O, Harrison R, et al. BMJ Qual Saf. 2019;28:382-388.
Risk aversion in clinical practice may lead to the ordering of unnecessary tests and procedures, a form of overuse that may pose harm to patients. Experienced clinicians may be more comfortable with uncertainty and risk than less experienced providers. In this cross-sectional study, researchers surveyed doctors working in three emergency departments to understand their level of experience and used vignettes to characterize their reactions to uncertainty and risk. They found a significant association between more clinical experience and less risk aversion as well as a significant association between more experience and greater ease with uncertainty. The authors caution that they cannot draw conclusions on how these findings impact patient safety. An accompanying editorial suggests that feedback is an important mechanism for improving confidence in clinical decision-making. A WebM&M commentary discussed risks related to overdiagnosis and medical overuse.
Kämmer JE, Hautz WE, Herzog SM, et al. Med Decis Making. 2017;37:715-724.
Measuring and addressing diagnostic error remains challenging. A prior study showed that when providers had similar individual diagnostic accuracy rates, pooling their assessments led to improved decision accuracy. This computer simulation study analyzed 1710 diagnoses provided by 285 medical students for 6 simulated patients presenting to the emergency room. Investigators found that pooling independent assessments led to enhanced diagnostic accuracy as compared to the average independent assessment, further supporting the idea that collective intelligence may help prevent diagnostic error.
Amaral ACK-B, Barros BS, Barros CCPP, et al. Am J Respir Crit Care Med. 2014;189:1395-401.
This study revealed that cross-coverage, in which physicians care for patients they have learned about through handoffs, was associated with lower mortality in the intensive care unit. This finding counters persisting concerns about harm related to discontinuity of care. The authors suggest that an independent assessment by a second physician may mitigate cognitive errors.