Implementation of diagnostic pauses in the ambulatory setting

Huang, Grace C.; Kriegel, Gila; Wheaton, Carolyn; Sternberg, Scot B.; Sands, Kenneth; Richards, Jeremy B.; Johnston, Katherine; Aronson, Mark D.

doi:10.1136/bmjqs-2017-007192

Cited by 20 publications

(14 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…As it is difficult to remember the massive amount of information needed to treat all diseases, approaches like cognitive aids, rules, and policies have been used to assist clinicians in the best course of action. Such approaches can have a modest impact on appropriate test utilization [20,55]. A cluster-randomized trial of a diagnostic and therapeutic algorithm for suspected UTI failed to have any impact on the number of urine cultures ordered [56].…”

Section: Cognitive Aids Rules and Policiesmentioning

confidence: 99%

Quality Improvement Interventions and Implementation Strategies for Urine Culture Stewardship in the Acute Care Setting: Advances and Challenges

Advani

Vaughn

2021

Curr Infect Dis Rep

View full text Add to dashboard Cite

Purpose ofReview-The goal of this article is to highlight how and why urinalyses and urine cultures are misused, review quality improvement interventions to optimize urine culture utilization, and highlight how to implement successful, sustainable interventions to improve urine culture practices in the acute care setting. Recent Findings-Quality improvement initiatives aimed at reducing inappropriate treatment of asymptomatic bacteriuria often focus on optimizing urine test utilization (i.e., urine culture stewardship). Urine culture stewardship interventions in acute care hospitals span the spectrum of quality improvement initiatives, ranging from strong systems-based interventions like suppression of urine culture results to weaker interventions that focus on clinician education alone. While most urine culture stewardship interventions have met with some success, overall results are mixed, and implementation strategies to improve sustainability are not well understood.Summary-Successful diagnostic stewardship interventions are based on an assessment of underlying key drivers and focus on multifaceted and complementary approaches. Individual intervention components have varying impacts on effectiveness, provider autonomy, and sustainability. The best urine culture stewardship strategies ultimately include both technical and socio-adaptive components with long-term, iterative feedback required for sustainability.

show abstract

Section: Cognitive Aids Rules and Policiesmentioning

confidence: 99%

Quality Improvement Interventions and Implementation Strategies for Urine Culture Stewardship in the Acute Care Setting: Advances and Challenges

Advani

Vaughn

2021

Curr Infect Dis Rep

View full text Add to dashboard Cite

show abstract

“…A pause, for example during handwashing after a physical examination, may be a deliberate strategy that a clinician uses to structure thinking time into a clinical interaction . Huang et al conducted a pilot study of a structured diagnostic pause after a consultation in an ambulatory care setting . Although only a minority of cases resulted in a change of approach, the study opened up possibilities for more integrated approaches to diagnostic pauses …”

mentioning

confidence: 99%

Silence is golden

Cooke

Mitchell

2018

Med Educ

View full text Add to dashboard Cite

show abstract

“…Fifteen out of the 25 checklists addressed Work Systems 20 22 42–53. Two of those checklists addressed the Persons subcomponent,45 46 13 addressed Tasks,20 22 42 43 45 47–53 and 3 addressed Internal Environment (table 1). 44–46 Notably, no checklists focused on Tools and Technologies, or External Environment.…”

Section: Resultsmentioning

confidence: 99%

Checklists to reduce diagnostic error: a systematic review of the literature using a human factors framework

Al-Khafaji

Townsend

et al. 2022

BMJ Open

View full text Add to dashboard Cite

ObjectivesTo apply a human factors framework to understand whether checklists reduce clinical diagnostic error have (1) gaps in composition; and (2) components that may be more likely to reduce errors.DesignSystematic review.Data sourcesPubMed, EMBASE, Scopus and Web of Science were searched through 15 February 2022.Eligibility criteriaAny article that included a clinical checklist aimed at improving the diagnostic process. Checklists were defined as any structured guide intended to elicit additional thinking regarding diagnosis.Data extraction and synthesisTwo authors independently reviewed and selected articles based on eligibility criteria. Each extracted unique checklist was independently characterised according to the well-established human factors framework: Systems Engineering Initiative for Patient Safety 2.0 (SEIPS 2.0). If reported, checklist efficacy in reducing diagnostic error (eg, diagnostic accuracy, number of errors or any patient-related outcomes) was outlined. Risk of study bias was independently evaluated using standardised quality assessment tools in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses.ResultsA total of 30 articles containing 25 unique checklists were included. Checklists were characterised within the SEIPS 2.0 framework as follows: Work Systems subcomponents of Tasks (n=13), Persons (n=2) and Internal Environment (n=3); Processes subcomponents of Cognitive (n=20) and Social and Behavioural (n=2); and Outcomes subcomponents of Professional (n=2). Other subcomponents, such as External Environment or Patient outcomes, were not addressed. Fourteen checklists examined effect on diagnostic outcomes: seven demonstrated improvement, six were without improvement and one demonstrated mixed results. Importantly, Tasks-oriented studies more often demonstrated error reduction (n=5/7) than those addressing the Cognitive process (n=4/10).ConclusionsMost diagnostic checklists incorporated few human factors components. Checklists addressing the SEIPS 2.0 Tasks subcomponent were more often associated with a reduction in diagnostic errors. Studies examining less explored subcomponents and emphasis on Tasks, rather than the Cognitive subcomponents, may be warranted to prevent diagnostic errors.

show abstract

Implementation of diagnostic pauses in the ambulatory setting

Abstract: This pilot represents the first known examination of diagnostic pauses in the outpatient setting, and this work potentially paves the way for more broad-based systems and/or electronic interventions to address diagnostic error.

Cited by 20 publications

References 17 publications

Quality Improvement Interventions and Implementation Strategies for Urine Culture Stewardship in the Acute Care Setting: Advances and Challenges

Quality Improvement Interventions and Implementation Strategies for Urine Culture Stewardship in the Acute Care Setting: Advances and Challenges

Silence is golden

Checklists to reduce diagnostic error: a systematic review of the literature using a human factors framework

Contact Info

Product

Resources

About