6 strategies to reduce clinical and diagnostic errors

Bob Latino blatino at RELIABILITY.COM
Wed Jul 18 11:12:58 UTC 2018


FYI - Here is a HC example using the FRAM model I mentioned previously.

While FRAM is an exhaustive approach, I am learning it is quite resilient when applied to complex systems, but impractical to be used on less complex issues that don't warrant the level of discipline required for FRAM.  I believe the issue of Dx Error meets the requirement of complexity to consider a FRAM analysis.  But I am not the domain expert on this forum, so I will leave that up to the professionals:-)

Robert J. Latino, CEO
Reliability Center, Inc.
1.800.457.0645
blatino at reliability.com
www.reliability.com
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From: Tom Benzoni [mailto:benzonit at GMAIL.COM]
Sent: Tuesday, July 17, 2018 10:10 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: Re: [IMPROVEDX] 6 strategies to reduce clinical and diagnostic errors

Might I suggest:
Start with definitions.
See Lown Institute article:
http://lowninstitute.org/news/blog/what-exactly-do-we-mean-by-overdiagnosis/
You could use the method and framework herein; errors fit pretty neatly into this construct.

tom benzoni
If you don't trust links (a good strategy; only the paranoid survive) search for the Lown Institute home page; see lower left corner.


On Mon, Jul 2, 2018 at 6:48 PM ROBERT M BELL <0000000296e45ec4-dmarc-request at list.improvediagnosis.org<mailto:0000000296e45ec4-dmarc-request at list.improvediagnosis.org>> wrote:
Dear Nelson,

Yes, Yes, Yes.

I have believed for some years that the way to go is to continue with research on diagnosis (Biases, basic research, etc.) but to also work on improving the accuracy of everything that is used to help us make diagnoses, particularly those areas where there is known large variations of test accuracy. My thinking is that is the quickest way to save lives and injury in patients.

If we just use the biases, basic research, etc to measure lives saved we will not know if the results are due to a decline or improvement in the supporting tests we use.  So lets better sort those out first and, in addition, use communication - be it CME, Radiological sessions, Time out sessions for all difficult situations, not just prior to operations. (? something like the system introduced at the world soccer cup taking place in Russia now, where the referee consults with experts at a distance to clarify whether a foul has been committed).

Also we could all well learn from others be it from different industries or from even international medical practices. Do we really know what works well in other countries?

I really, really think SIDM could set the way forward, particularly if they had reasonable time related goals on many of these things. a big task, but not impossible.

And let’s start with the simpler things first!?

To some extent we are in the situation where information sharing has become a rare animal, probably because of the recession we have been through, where information costs could be cut and less noticed.

I would guess the Medical Industry would not initiate information sharing advances/changes if they created significant costs.

So the pressure would have to come from others. Patients, Safety organizations, we speaking out on this list, etc., etc.

Thanks for great ideas.

Rob Bell








On Jul 2, 2018, at 6:25 AM, Nelson Toussaint <ntoussaint at TAMARAC.COM<mailto:ntoussaint at TAMARAC.COM>> wrote:



July 2, 2018
8:49 AM
Dr. Bell

From my perspective, this IS the issue in Improving Diagnostic Error.  We all have limited experience and ability, needing the help of our partners to make the best decisions.  The pressures of time, money and patient involvement work against cooperation with other knowledgable resources.  The success of mankind in the 20th Century comes from teamwork and cooperation.  Even when a great discovery is made by an individual, it doesn't get into practice without the teamwork of the "implementers".

Aerospace had a similar culture during the great boon years of the 1960's and 70's where much of the decision making was autocratic.  In the late 1980's and 1990's, mistakes and failures were mush less tolerated by the marketplace.  This spawned the Integrated Product Team (IPT) where the different disciplines work together to keep a project on a successful track.  The IPT still has a leader (i.e. the clinician) but forward movement isn't allowed until the situation is reviewed with the Team (clinician, patient, radiologist or other specialist).  This has been very successful and has been implemented throughout DOD and many other industries.  Although, not to say this is needed in every case!

Although I am not sure, I think a similar system is somewhat active in the Operating Room.  I think this is also employed in certain difficult cases (grand rounds).  Maybe it needs to be more widely spread in the diagnostic area (as it was in the past).  I hear there are several test cases underway.  I don't know how to accomplish this on a wide-scale basis, but it will likely take an industry movement.

   Nelson Toussaint

TAMARAC LLC
860-844-0199
ntoussaint at tamarac.com<mailto:ntoussaint at tamarac.com>

From: ROBERT M BELL [mailto:0000000296e45ec4-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG]
Sent: Sunday, July 01, 2018 11:19 PM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
Subject: Re: [IMPROVEDX] 6 strategies to reduce clinical and diagnostic errors

Thanks Helen, Thanks David,

CME at hospitals, at least in Northern Arizona, has almost disappeared. I presume because it costs too much. Also, visits to discuss with the radiologist, I hear, in many centers are dead. Both places where physicians learnt so much in the past.

David, if communication is so important why is this happening. Is this just because of cost?

On my hobby horse again, is this something SIDM could change to help the diagnostic process - could that be a five year goal?

Rob Bell M.D.
On Jul 1, 2018, at 6:35 PM, David Meyers <dlmmd12 at GMAIL.COM<mailto:dlmmd12 at GMAIL.COM>> wrote:

Helene Epstein has shared this home page which has links to a number of interesting articles.

David
David L Meyers, MD FACEP
Listserv Moderator/Board member
Society to Improve Diagnosis in Medicine
www.improvediagnosis.org<http://www.improvediagnosis.org/> |
Save the Dates: Diagnostic Error in Medicine, November 4-6, 2018; New Orleans, LA
Diagnostic Error in Medicine-2nd European Conference, August 30-31, 2018; Bern, Switzerland


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