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Posted: April 29th, 2018
Reducing Diagnostic Errors in Primary Care
Diagnostic errors are a major source of preventable harm in health care, affecting millions of patients worldwide. According to a recent report by the World Health Organization, diagnostic errors occur in up to 15% of clinical encounters and contribute to 10% of patient deaths and 17% of adverse events in hospitals. Primary care is particularly vulnerable to diagnostic errors, as it involves complex and uncertain situations, high workload and time pressure, and limited access to diagnostic tests and specialists.
However, primary care also offers unique opportunities for reducing diagnostic errors, as it is the first point of contact for most patients and the gateway to the rest of the health system. Primary care providers can play a key role in improving diagnosis by applying evidence-based strategies, such as:
– Enhancing clinical reasoning skills: Clinical reasoning is the cognitive process that leads to a diagnosis. It involves gathering and interpreting relevant information, generating and testing hypotheses, and reaching a conclusion. Clinical reasoning can be improved by using structured tools, such as checklists, algorithms, or decision aids, that help avoid cognitive biases and gaps in knowledge. Additionally, primary care providers can seek feedback and learn from their own and others’ diagnostic experiences, such as through case discussions, audits, or peer review.
– Engaging patients and families: Patients and families are essential partners in the diagnostic process, as they provide valuable information, preferences, and perspectives that can influence the diagnosis. Primary care providers can engage patients and families by eliciting their concerns and expectations, encouraging them to ask questions and share their opinions, and involving them in decision making and follow-up. Moreover, primary care providers can empower patients and families to participate in their own care by providing them with clear and accurate information, education, and support.
– Collaborating with other health professionals: Diagnosis is often a team effort that requires input from different health professionals, such as nurses, pharmacists, laboratory technicians, or specialists. Primary care providers can collaborate with other health professionals by establishing effective communication channels, sharing relevant information, seeking consultation or referral when needed, and coordinating care across settings and transitions. Furthermore, primary care providers can foster a culture of safety and learning within their teams by promoting mutual respect, trust, and feedback.
Reducing diagnostic errors in primary care is a complex and multifaceted challenge that requires a systems approach. Primary care providers can contribute to this goal by implementing evidence-based strategies that enhance their clinical reasoning skills, engage patients and families, and collaborate with other health professionals. By doing so, they can improve the quality and safety of care for their patients and the health system as a whole.
Bibliography
– World Health Organization. (2021). Improving Diagnosis in Health Care: A Global Perspective. Geneva: WHO.
– Singh H., Meyer A.N.D., Thomas E.J. (2014). The frequency of diagnostic errors in outpatient care: estimations from three large observational studies involving US adult populations. BMJ Quality & Safety 23(9):727–731.
– Graber M.L., Rusz D., Jones M.L., dissertation topics examples Farm-Franks D., Jones B., Cyr Gluck J., Singh H. (2019). The new diagnostic team. Diagnosis 6(4): 403–408.
– Croskerry P., Nimmo G.R. (2011). Better clinical decision making and reducing diagnostic error. Journal of the Royal College of Physicians of Edinburgh 41(2):155–162.
– Schiff G.D., Hasan O., Kim S., Abrams R., Cosby K., Lambert B.L., Elstein A.S., Hasler S., Kabongo M.L., Krosnjar N., Odwazny R., Wisniewski M.F., McNutt R.A. (2009). Diagnostic error in medicine: analysis of 583 physician-reported errors. Archives of Internal Medicine 169(20):1881–1887.
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