Good news and bad: The CHARMED trial of second opinions in the ED
ntoussaint at TAMARAC.COM
Tue Apr 24 19:08:59 UTC 2018
April 24, 2018
Unfortunately, this study (CHARMED Trial) seems not to have included cross-checking during the individual diagnosis period.
I believe the primary benefit in cross-checking (or team participation) or a Differential Diagnosis will be the emphasis of the attending physician to re-examine what early conclusions may present, while the issue is hot. Gaining surety of the diagnosis is of utmost importance, otherwise it become a good guess. Certainly, there is also benefit to a different set of eyes and experiences; however, one physician vs. another will likely achieve only two different opinions.
The real improvement will come when "critical thinking" (challenging one's own conclusions) and differential diagnosis become a natural element of the attending physicians diagnosis process. This may not ever be truly measurable (like keeping your eyes on the road while driving), but will hopefully become an instinctive mode of operation.
<mailto:ntoussaint at tamarac.com> ntoussaint at tamarac.com
From: Mark Graber [mailto:Mark.Graber at IMPROVEDIAGNOSIS.ORG]
Sent: Tuesday, April 24, 2018 10:13 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: [IMPROVEDX] Good news and bad: The CHARMED trial of second opinions in the ED
The just-published results of the French CHARMED trial <https://www.medpagetoday.com/emergencymedicine/emergencymedicine/72493?xid=nl_mpt_DHE_2018-04-24&eun=g984329d0r&pos=1&utm_source=Sailthru&utm_medium=email&utm_campaign=Daily%20Headlines%202018-04-24&utm_term=Daily%20Headlines%20-%20Active%20User%20-%20180%20days> found that having a second ER physician ‘cross check’ the diagnosis and plans for ER patients reduced adverse events by 40% (10.7 vs 6.4%) and near misses (5.8 vs 3.1%) by a comparable 47%. The good news is that the intervention seemed to work. The bad news is that while the near miss reduction was statistically significant in this trial of 1680 patients, the adverse event reduction was not. This demonstrates how difficult it will be to study true outcomes in diagnostic error reduction, even in settings where the incidence is fairly large (the authors cite an ED error rate of 10% as being the norm).
Mark L Graber MD FACP
Senior Fellow, RTI International
Professor Emeritus, Stony Brook University
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