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EXAMINING ACUTE DIAGNOSTIC MISTAKES USING A PROCESS-
DRIVEN METHODOLOGY AND THE IMPORTANCE OF REMOVING
THEM
Zamira Madaminova Qodirbergan qizi
Medical laboratory assistant of Cardo star plus
https://doi.org/10.5281/zenodo.16636924
Introduction.
Cognitive biases and other cognitive errors, which are
influenced by variables unique to patients, illnesses, healthcare systems, and
physicians, are frequently the source of diagnostic errors. When diagnosing
routine instances, an experienced physician utilizes non-analytic reasoning that
is intuitive, effortless, and automatic. When diagnosing atypical or complex
clinical cases, they use analytical reasoning that requires conscious cognitive
effort. But it's impossible to totally prevent diagnostic errors [1,2]. It is best to
use a variety of information sources to reduce the likelihood of diagnostic
errors, such as the clinician's own experience, professional judgment, statistical
principles, evidence-based data, and, if available, carefully thought-out
algorithms and guidelines. In order to improve the clinician's diagnostic abilities
and hence lower the chance of diagnostic error, it is also critical to regularly
participate in introspective, metacognitive, and deliberate behaviors. This
narrative review's objective was to draw attention to certain elements that
affect the development of diagnostic mistakes [3,4]. Clinicians, health care
system managers, and public health policy makers may find it easier to develop
strategies and guidelines to lower the incidence and prevalence of the public
health hazard known as clinical diagnostic error if they have a better
understanding of the dynamic, adaptive, and complex interactions among these
factors [5].
Material and methods.
Through our interpretation of the authors'
scientific research, we have taken into consideration methods in the offered
paper that help to reduce diagnostic errors. The authors carried out a four-year
retrospective analysis at a major academic medical institution in the United
States, focusing on adult patients who were under the general medicine service's
care at a certain stage of their hospital stay. Using the Safer Dx tool, two doctors
independently examined the comprehensive records of cases that were
purposively picked from reputable institutional case review forums and
evaluated the risk of diagnostic error. The frequency of failure points (FPs) and
important FPs in the diagnostic process were described by each reviewer using
the updated Diagnostic Error Evaluation and Research (DEER) taxonomy, which
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was upgraded for acute care (over 40 potential failure points across six process
dimensions).
Results.
Approximately 20 out of 170 medical error cases were sampled; of
these, 14 (82.0%) had one or more diagnostic errors, and a total of
approximately 115 FPs, 30 of which were serious FPs. The process dimensions
of "Diagnostic Information and Patient Follow-up" and "Patient and Provider
Encounter and Initial Assessment" accounted for the bulk of significant FPs
(more than 60.0%). At least one of these dimensions had a substantial FP in 14
cases (about 88.0%).
Conclusions.
Diagnostic errors appear to be the most common, costly, and
damaging medical errors that affect both inpatients and outpatients, according
to recent data from malpractice claims. Incorrect laboratory test ordering and
incorrect utilization of test data are major contributors to diagnostic mistakes
and persistent problems with test performance.
Authors purposively sampled group experienced diagnostic process failures
in a number of aspects. Important insights into significant diagnostic process
failures that might be the focus of preventative measures were provided by a
methodical analytical methodology that included the modified DEER taxonomy,
which had been updated for acute care.
In conclusion, our analysis’s findings offer a fresh perspective on
examining diagnostic error situations in acute care settings and provide initial
knowledge for creating new procedures and treatments that reduce diagnostic
process errors. Future research should employ techniques like critical incident
interviews of recent instances with a high likelihood of diagnostic error in order
to more thoroughly capture the occurrence and importance of failure points
from these aspects.
References:
1.
Griffin JA, Carr K, Bersani K, Piniella N, Motta-Calderon D, Malik M, Garber
A, Schnock K, Rozenblum R, Bates DW, Schnipper JL, Dalal AK. Analyzing
diagnostic errors in the acute setting: a process-driven approach. Diagnosis
(Berl). 2021 Aug 23;9(1):77-88. doi: 10.1515/dx-2021-0033.
2.
Vally ZI, Khammissa RAG, Feller G, Ballyram R, Beetge M, Feller L. Errors in
clinical diagnosis: a narrative review. Journal of International Medical Research.
2023;51(8). doi:10.1177/03000605231162798
3.
Croskerry P. The rational diagnostician and achieving diagnostic
excellence. JAMA 2022; 327: 317–318.
4.
Plessas A, Nasser M, Hanoch Y, et al. Impact of time pressure on dentists’
diagnostic performance. J Dent 2019; 82: 38–44.
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5.
Berthet V. The impact of cognitive biases on professionals’ decision-
making: A review of four occupational areas. Front Psychol 2022; 12: 802439.
