Effectiveness of a clinical knowledge support system for reducing diagnostic errors in outpatient care in Japan: A retrospective study

Shimizu, Taro; Nemoto, Takaaki; Tokuda, Yasuharu

doi:10.1016/j.ijmedinf.2017.09.010

Cited by 33 publications

(31 citation statements)

References 32 publications

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“…Point‐of‐care clinical information and decision support tools, such as UpToDate, Dynamed, and Clinical Key, are essential to reducing diagnostic errors . In the recent study by Shimizu et al ., UpToDate exposure was significantly associated with an error rate reduction, with an OR of 15.21 (95%CI: 1.86–124.36) . UpToDate aided in prompt decision‐making and improved the efficiency of clinical management.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic errors in pediatric bacterial osteomyelitis

Otani

Aizawa

Hataya

et al. 2019

Pediatrics International

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Background: Clinical evidence for improving diagnostic accuracy in pediatric medicine is still scarce. Septic osteomyelitis is sometimes challenging for physicians to diagnose. The aim of this study was to improve patient care through identifying the incidence and reasons for errors in the diagnosis of bacterial osteomyelitis in pediatric patients. Methods: We retrospectively identified patients younger than 16 years with acute or chronic osteomyelitis at Tokyo Metropolitan Children's Medical Center between April 2010 and September 2017. We extracted data on patient demographics, clinical course, symptoms, locus of the lesions, and diagnosis at presentation and discharge. The patients were categorized into the misdiagnosis and non-misdiagnosis groups following a review by two pediatricians. Misdiagnosis was defined as a difference between the initial and discharge diagnosis. The factors in the two groups were compared, and the types of error in the misdiagnosis group were examined. Results: In total 71 patients were enrolled. The median age and proportion of boys was 7.6 years (IQR, 1.4-11.2 years) and 66%, respectively. Misdiagnosis occurred in 27 patients (38.0%). Precedent antibiotic use was independently associated with misdiagnosis (P = 0.044). A cognitive error was observed in 88.3% of the misdiagnosis group. The median number of types of error per case was 2.0 (IQR, 2.0-3.0). Conclusions: The misdiagnosis of septic osteomyelitis in pediatric patients was common and chiefly caused by cognitive errors. Eliminating cognitive errors in diagnosis is highly likely to improve the care of patients with osteomyelitis.

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Section: Discussionmentioning

confidence: 99%

Diagnostic errors in pediatric bacterial osteomyelitis

Otani

Aizawa

Hataya

et al. 2019

Pediatrics International

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“…Residents and attending physicians are comfortable with searching UpToDate and retrieving validated evidence syntheses [28]. Physicians relying on UpToDate are less prone to diagnostic errors [29]. This is a portable resource that can aid even during clinical rounds [30].…”

Section: Current Barriers To Knowledge In Rheumatologymentioning

confidence: 99%

Moving towards online rheumatology education in the era of COVID-19

2020

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The coronavirus disease-2019 (COVID-19) pandemic has unsettled conventional medical education, hastening a switch to digital platforms and open-access publishing. Rheumatology is a fast evolving academic discipline that stands to gain by this switch. Most rheumatology textbooks are now available in digital formats, and these are complemented with live updating educational hubs such as UpToDate and ClinicalKey. Emerging topics of COVID-19 on these proprietary platforms are now freely available to all specialists. Social media channels, particularly Twitter, are becoming major players in the era of COVID-19 by offering online journal clubs, enabling fast dissemination of influential articles, and facilitating interactive education. Indexed rheumatology journals, in turn, aid online education by opening access to recommendations and other materials that are rapidly changing research and practice worldwide. Research peer review additionally offers learning experience to novice and seasoned researchers and authors. Global rheumatology societies have online learning resources, which are changing their format and geographic reach to meet the changing needs in the times of pandemic. While online teaching lacks emotional connections between mentors and mentees, switch to a more interactive format of education and regular contacts may partly solve the issue. Rheumatologists can take the lead in these challenging times and contribute more to online scholarly activities which are aimed to maintain and enrich education.

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“…In medicine a paradigm shift is needed where instead of memorizing differentials and treatments, we use evidence‐based algorithms, protocols, checklists, practice guidelines and clinical decision rules to mitigate cognitive strain. The selective use of information technology, such as UpToDate (a computer‐based clinical knowledge support system) has been shown to effectively reduce diagnostic error from 24% in the control group to 2% in exposure group . Checklists have long been used by high‐risk professions like airline pilots, nuclear plant operators and submarine crews, and more recently they have been found to cut surgical deaths by half and reduce wrong‐site surgeries when instated in operating rooms .…”

Section: Fatigue and Cognitive Strainmentioning

confidence: 99%

Diagnostic heuristics in dermatology, part 2: metacognition and other fixes

Lowenstein

Sidlow

2018

Br J Dermatol

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Diagnostic errors are the most common, costly and dangerous of medical mistakes. In part 1 of this series, we described how general and dermatology-specific cognitive and perceptual biases underlie most of our correct diagnoses, as well as being a source of diagnostic medical errors. In this second part of the series, we describe some tactics to combat diagnostic error. Metacognition, or thinking about how we think, is the central approach advocated to avoid errors of 'uncritical' diagnostic thinking. Current individual and medical cultural attitudes need to be modified in order to incorporate improvements in diagnosis. Algorithms, artificial intelligence and system changes are being developed to address error and improve diagnostic accuracy.

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Effectiveness of a clinical knowledge support system for reducing diagnostic errors in outpatient care in Japan: A retrospective study

Cited by 33 publications

References 32 publications

Diagnostic errors in pediatric bacterial osteomyelitis

Diagnostic errors in pediatric bacterial osteomyelitis

Moving towards online rheumatology education in the era of COVID-19

Diagnostic heuristics in dermatology, part 2: metacognition and other fixes

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