The pitfalls of premature closure: clinical decision-making in a case of aortic dissection

Kumar, Bharat; Kanna, Balavenkatesh; Kumar, Suresh

doi:10.1136/bcr.08.2011.4594

Cited by 22 publications

(12 citation statements)

References 10 publications

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“…In an attempt to clarify questions about the ability to overcome the tendency to make decisions before sufficient information has been gathered, referred to as ‘premature closure’, this study focuses exclusively on those circumstances in which clinicians are confronted with information that is inconsistent or disconfirming. Kruglanski and Webster describe the problem of premature closure as one of ‘seizing’ and ‘freezing’ .…”

Section: Introductionmentioning

confidence: 99%

Avoiding premature closure and reaching diagnostic accuracy: some key predictive factors

et al. 2017

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Section: Introductionmentioning

confidence: 99%

Avoiding premature closure and reaching diagnostic accuracy: some key predictive factors

et al. 2017

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“…However, a top-down reasoning approach is often associated with novices and are vulnerable to diagnostic errors related to cognitive biases and premature closure 27 28. Such errors arise when residents fail to consider additional pertinent information related to a disease or situation29–31 leading to misdiagnosis or delayed diagnosis 31. Although we did not evaluate the effectiveness of the residents’ narrative strategy, their use of such a strategy highlights potential patient safety pitfalls.…”

Section: Discussionmentioning

confidence: 96%

‘This is our liver patient…’: use of narratives during resident and nurse handoff conversations

2019

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ObjectiveHandoffs are often framed as the co-construction of a shared understanding relying on narrative storytelling. We investigated how narratives are constructed and used during resident and nurse handoff conversations.MethodWe audio-recorded resident (n=149) and nurse (n=126) handoffs in an inpatient medicine unit. Qualitative analysis using grounded theory was conducted to identify and characterise the structure of resident and nursing handoff narratives.ResultsHandoff conversations among both residents and nurses used three types of narratives: narratives on creating clinical imagery, narratives on coordinating care continuity and narratives on integrating contextual aspects of care. Clinical imagery narratives were common during patient introductions: residents used a top-down approach relying on overarching patient clinical situations (eg, ‘a liver patient’), whereas nurses used a bottom-up approach using patient-specific identifying information. Narratives on the coordination of care continuity for residents focused on managing internal and external coordination activities, whereas nurse narratives focused on internal coordination, emphasising their role as an interface between patients and their physicians. Both resident and nurse narratives on the contextual aspects of care had considerable focus on highlighting ‘heads up’ anticipatory information and personal patient information; such information was often not present in patient charts, but was important for ensuring effective care management.DiscussionThe presence of narrative structures highlights the need for new perspectives for the design of handoff tools that allow for both informational and cognitive support and shared awareness among conversational partners during handoff conversations. We discuss the implications of the use of narratives for patient safety and describe specific design considerations for supporting narrative interactions during handoffs.

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“…Following this thought process, the participants did not regard near misses as diagnostic errors. The knowledge and skill of the dental professional, such as recognizing one's limitations and succumbing to cognitive biases, 40 are welldocumented factors that may lead to errors. Such events often include accidental aspiration of foreign bodies.…”

Section: Discussionmentioning

confidence: 99%

“…39 Several contributing factors and strategies for improvement were identified in our interviews that related to the characteristics of the dentist, the patient, and the overarching organization, system, or policies. The knowledge and skill of the dental professional, such as recognizing one's limitations and succumbing to cognitive biases, 40 are welldocumented factors that may lead to errors. 41,42 The breakdown of communication among colleagues or between the provider and the patient is also known to lead to problematic situations.…”

Section: Discussionmentioning

confidence: 99%

Clinical Dental Faculty Members’ Perceptions of Diagnostic Errors and How to Avoid Them

Nikdel¹,

Nikdel²,

Ibarra-Noriega³

et al. 2018

Journal of Dental Education

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Diagnostic errors are increasingly recognized as a source of preventable harm in medicine, yet little is known about their occurrence in dentistry. The aim of this study was to gain a deeper understanding of clinical dental faculty members' perceptions of diagnostic errors, types of errors that may occur, and possible contributing factors. The authors conducted semi-structured interviews with ten domain experts at one U.S. dental school in May-August 2016 about their perceptions of diagnostic errors and their causes. The interviews were analyzed using an inductive process to identify themes and key findings. The results showed that the participants varied in their definitions of diagnostic errors. While all identified missed diagnosis and wrong diagnosis, only four participants perceived that a delay in diagnosis was a diagnostic error. Some participants perceived that an error occurs only when the choice of treatment leads to harm. Contributing factors associated with diagnostic errors included the knowledge and skills of the dentist, not taking adequate time, lack of communication among colleagues, and cognitive biases such as premature closure based on previous experience. Strategies suggested by the participants to prevent these errors were taking adequate time when investigating a case, forming study groups, increasing communication, and putting more emphasis on differential diagnosis. These interviews revealed differing perceptions of dental diagnostic errors among clinical dental faculty members. To address the variations, the authors recommend adopting shared language developed by the medical profession to increase understanding.

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The pitfalls of premature closure: clinical decision-making in a case of aortic dissection

Cited by 22 publications

References 10 publications

Avoiding premature closure and reaching diagnostic accuracy: some key predictive factors

Avoiding premature closure and reaching diagnostic accuracy: some key predictive factors

‘This is our liver patient…’: use of narratives during resident and nurse handoff conversations

Clinical Dental Faculty Members’ Perceptions of Diagnostic Errors and How to Avoid Them

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