Personal diagnostic error audit tool?

Kohn, Michael Michael.Kohn at UCSF.EDU
Thu Feb 9 18:15:35 UTC 2017


I have an interest tangentially related to this thread: teaching diagnosis to trainees.  The key to good diagnosis is experience, and experience often means bad diagnosis.  We should expose trainees to as many real cases as possible.  With modern technology, that can be done using online interfaces with case presentation, images, video, etc.  This is not as good as seeing patients in real life, but it is much more efficient, and the mistakes won't hurt anybody.  The key is to require the trainee to elicit the information rather than providing it from the start.

Frontline clinicians need the reverse application.  We need to be able to present the case and have the decision support tool ask questions.  For example, I present a young man with recurrent episodes of severe abdominal pain with nausea and vomiting.  The program asks whether he smokes marijuana and whether hot showers relieve the pain.  If you don't know why, read Lisa Sanders's "Every Patient Tells a Story" (Ch 1).  (Lisa, If you are reading this, send the promotional fee to my UCSF address.)

These ideas are directed at preventing diagnostic errors, not identifying and quantifying them once they are made. As we have discussed on this list and in this thread, objective identification and quantification of diagnostic errors can be very difficult; misses should be balanced against overdiagnosis and overtreatment.

MAK


Michael A. Kohn, MD, MPP

Associate Professor

Epidemiology and Biostatistics

(Email created using voice recognition.  Please excuse transcription errors.)

________________________________
From: Edward Winslow [edbjwinslow at GMAIL.COM]
Sent: Thursday, February 09, 2017 8:22 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: Re: [IMPROVEDX] Personal diagnostic error audit tool?

Shadia,

Unfortunately, there are few resources on using IT tools to find and evaluate diagnostic error.

However Hardeep Singh from Houston has done several studies on evaluating Diagnostic Error. He and his colleagues have developed a tool, called "The SAFER Dx" Tool.
The tool is well described in  Davalos, MC et al: "Finding Diagnostic Errors in Children Admitted to the PICU": Pediatric Critical Care Medicine.
https://www.researchgate.net/publication/312932270_Finding_Diagnostic_Errors_in_Children_Admitted_to_the_PICU

This and its reference list might be a good starting point for your resident.  Best of luck in your project.

Let us know what your resident comes up with. We are trying to come up with a series of references on Tools to help reduce Dx. Error, both manual and computer assisted.

Ted

On Thu, Feb 9, 2017 at 12:10 AM, Shadia Constantine <shadiasconstantine at gmail.com<mailto:shadiasconstantine at gmail.com>> wrote:
Dear Colleagues,

One of my residents is interested in learning a process to learned from a diagnostic error once it has happened, so she can identify the potential cause.  She is thinking about a process done as part of personal performance improvement.
We are reviewing the checklists available in the website to see if they can be used in retrospect but wonder if any of you know of any additional resource or publication.
thank you!

Shadia
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