Diagnostic omission errors in acute paediatric practice: impact of a reminder system on decision-making

Abstract

Background: Diagnostic error is a significant problem in specialities characterised by diagnostic uncertainty such as primary care, emergency medicine and paediatrics. Despite wide-spread availability, computerised aids have not been shown to significantly improve diagnostic decision-making in a real world environment, mainly due to the need for prolonged system consultation. In this study performed in the clinical environment, we used a Web-based diagnostic reminder system that provided rapid advice with free text data entry to examine its impact on clinicians' decisions in an acute paediatric setting during assessments characterised by diagnostic uncertainty.

Use of health information technology to reduce diagnostic errors

“…Four systems in current use (Isabel, DXplain, Diagnosis Pro and PEPID) were recently reviewed and evaluated on test cases 51. There have also been various evaluations of these systems and earlier counterparts (eg, QMR and Iliad) including retrospective52–58 and simulated cases53 59 60 as well as pre–post61 and prospective62 studies. In general, these studies—although not always rigorously performed—demonstrate that the systems include the gold standard diagnosis within the output list of up to 30 diagnoses in 70–95% of cases.…”

Characterising the nature of primary care patient safety incident reports in the England and Wales National Reporting and Learning System: a mixed-methods agenda-setting study for general practice

“…There is increasing support for the use of clinician decision support systems, to assist in managing consultations. 108,109 For example, a system proposed by de Wit et al 110 supports the management of polypharmacy in the elderly patient population.…”

Uptake and impact of a clinical diagnostic decision support tool at an academic medical center

“…In fact, simulations suggest that DDX generators have the potential to improve diagnostic accuracy [4][5][6][7]. However, there is a paucity of research examining the use of such systems in real-world settings [8], and even less is known about the impact of DDX generator use on patient care and resource utilization [9,10]. These issues are important because barriers such as those related to provider overconfidence and workflow could impede the use of DDX tools in real world settings.…”