This commentary offers insights from a radiologist regarding the role of unintentional blindness in diagnostic error. The author discusses a radiologic near miss and the variety of factors that could have contributed to it, such as bias, distraction, and inattention.
Medford-Davis LN, Singh H, Mahajan P. Pediatr Clin North Am. 2018;65:1097-1105.
The busy and complex emergency department environment harbors pressures can that hinder diagnostic safety. This review discusses the characteristics of emergency medicine that contribute to overreliance on heuristics and susceptibility to bias in decision making. The authors highlight the need to better monitor diagnostic error in the emergency department to inform the design of improvement activities. A previous WebM&M commentary discussed diagnostic delay in the emergency department.
Gupta A, Harrod M, Quinn M, et al. Diagnosis (Berl). 2018;5:151-156.
This direct observation study of hospitalist teams on rounds and conducting follow-up work examined the interaction between systems problems and cognitive errors in diagnosis. Researchers found that information gaps related to electronic health records, challenges with handoffs, and time constraints all contributed to difficulties in diagnostic cognition. The authors suggest considering both systems and cognitive challenges to diagnosis in order to promote safety.
This study used written medical cases to examine whether simulated time pressure or interruptions affect diagnostic accuracy among resident and attending emergency medicine physicians. While the experienced physicians answered the questions more quickly and accurately compared to resident physicians, diagnostic accuracy was not compromised by time pressure or interruptions for either group in this study.
Balint BJ, Steenburg SD, Lin H, et al. Acad Radiol. 2014;21:1623-8.
Interruptions are inevitable for busy clinicians, and recently studies have shown that interruptions can increase workload for physicians and raise the risk of medication administration errors by nurses. However, these safety risks must be balanced against the fact that interruptions are often necessary for patient care. This study analyzed data from telephone logs and a formal quality assurance program to examine the effect of telephone interruptions on accuracy of on-call radiology residents' study interpretations. The authors found that a higher frequency of interruptions was associated with more diagnostic errors. This study is one of the first to document clinical consequences of physician interruptions and adds to our understanding of systems contributors to diagnostic errors. An incident involving an incorrect overnight radiology interpretation is discussed in a past AHRQ WebM&M commentary.
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