The <scp>CARE</scp> approach to reducing diagnostic errors

Rush, J. Logan; Helms, Stephen E.; Mostow, Eliot N.

doi:10.1111/ijd.13532

Cited by 5 publications

(6 citation statements)

References 11 publications

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“…Preventive measures to avoid procedural and diagnostic errors include eliciting a thorough history, assessing for personal biases, and creating safety guidelines (Table 4). There are also ways to minimize the risk of liability when adverse outcomes do occur, such as contritely disclosing the error, addressing the error, and maintaining a strong relationship with the patient and family …”

Section: Discussionmentioning

confidence: 99%

Characteristics of Medical Liability Claims Against Dermatologists From 1991 Through 2015

et al. 2018

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IMPORTANCE Recognizing malpractice trends in the field of dermatology is important for establishing safeguards for patient care and minimizing liability. However, there is a lack of published data on malpractice claims against dermatologists. OBJECTIVE To determine characteristics of medical professional liability claims in the field of dermatology and to compare these claims with those against all physicians. DESIGN, SETTING, AND PARTICIPANTS We examined malpractice liability data collected on dermatologists and other physicians insured by companies that report data to the Physician Insurers Association of America Data Sharing Project (PIAA-DSP), a nationally representative liability claims registry. Data analyzed spanned the years 1991 through 2015. MAIN OUTCOMES AND MEASURES Demographic characteristics of dermatologists subject to claims, characteristics of closed claims, medical errors associated with closed claims, and patient outcomes leading to closed claims. RESULTS Data on a total of 90 743 closed claims were analyzed, 1084 (1.2%) against dermatologists and 89 659 (98.8%) against nondermatologists. More lawsuits were brought against male (n = 753, 69.5%) than female dermatologists (n = 270, 24.9%); 5.6% of claims (n = 61) did not identify the physician's sex. Full-time practitioners (n = 1035, 95.5%) and those in solo practice (n = 600, 55.4%) were more likely to be sued than those in group practices (n = 429, 39.6%) and institutions (n = 31, 2.9%). Most claims against dermatologists were abandoned, withdrawn, or dismissed (n = 735, 67.8%). Between 2006 and 2015, trial verdicts favoring defendants exceeded trial verdicts favoring plaintiffs by a factor of 7. Errors that occurred during a procedure spawned the most claims (n = 305), of which 102 were paid. Misdiagnoses comprised the second-highest number of claims (n = 192), of which 62 were paid. The average recovery per claim was $238 145. The most common procedure leading to claims was skin operations (420 claims, of which 130 were paid). The most common adverse patient outcome associated with claims was dyschromia, resulting in 171 claims, of which 40 were paid. CONCLUSIONS AND RELEVANCE Male dermatologists were sued more often than female dermatologists. Overall, alleged errors in procedures and misdiagnosis gave rise to the most lawsuits. Dyschromia was the most common adverse outcome alleged in lawsuits.

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Section: Discussionmentioning

confidence: 99%

Characteristics of Medical Liability Claims Against Dermatologists From 1991 Through 2015

et al. 2018

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“…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%

“…No checklists addressed the Physical subcomponent and only two checklists addressed the Social and Behavioural subcomponent of Processes (table 1). 48 50…”

Section: Resultsmentioning

confidence: 99%

“…Checklists that addressed the Social and Behavioural subcomponents encouraged person-to-person communication to ensure adequate knowledge transfer. For example, Rush’s CARE mnemonic incorporated ‘C’ to represent ‘ C ommunicate with your team and patient,’ while Nedorost’s checklist prompted physicians to consider ‘framing communication.’48 50…”

Section: Resultsmentioning

confidence: 99%

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

Al-Khafaji

Townsend

et al. 2022

BMJ Open

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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.

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“…Diferente da abordagem de erros em outras profissões não relacionadas diretamente a saúde que tratam o assunto como formas de estudo para melhoria na prestação de serviços e na prevenção de novos episódios (Burke et al, 2004;Rush; Helms; Mostow, 2017), observa-se que a própria classe de profissionais ligados à saúde apresenta uma tendência de acobertamento de seus insucessos (O'neil et al, 1993) evidenciada pela escassez de publicações sobre relatos de erro de diagnóstico.…”

Section: O Exame Necroscópicounclassified

Estudo de casuística e concordância diagnóstica do Serviço de Verificação de Óbitos do Interior (SVOi), em Ribeirão Preto, SP, no período de 2008 a 2012

Terada¹

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The Death Verification Service provides complementary information for public epidemiology services and public health policies that are useful as tools for measuring the health status of a community and for the elaboration and evaluation of health programs. Diagnostic comparison between cause of death clinical diagnosis and the autopsy is a tool used for auditing medical services, and despite technological advances, discrepancies are still high. The present study sought to evaluate the casuistry in the Death Verification Service-Interior (DVSi) from 2008 to 2012 and to compare them with the general mortality statistics of the Ribeirão Preto municipality, which were made available by the Ministry of Health. In addition, it aimed to classify the diagnostic discrepancies between the requests for autopsies and final results of examinations in deaths using the Goldman revised criteria and, from the obtained data, to make a critical analysis of the DVSi impact on diagnostic clarification and its importance in mortality statistics. For the application of the criteria, secondary data from the cadaver referral, final reports and mortality data of the Ministry of Health were used, and data analysis was performed through descriptive statistical analysis. The results showed that during the study periods, 4464 autopsies were performed in the service, with a predominance of male patients and age range from 51 to 90 years. Circulatory system diseases were the most prevalent causes of death, followed by respiratory diseases and neoplasms. Among all autopsied cases, it was possible to apply the Goldman revised criteria in 3895 (83.28%) cases and large discrepancies were attributed in 26.39% cases after the use of analysis filter criteria, which suggests the existence of discrepancies between the diagnostic hypothesis and the actual cause of death. It can be concluded that the local DVSi plays an important role in the diagnostic audit, evidenced by the cases that did not present a correlation between the hypothesis in the referral and the final autopsy report. In addition, 1228 (31.53%) cases were referred without hypothesis, that is, without suspicion of the underlying cause of death, highlighting the importance of the DVSi for its definition. Furthermore, the basic cause was solved after performing the autopsy in 99.54% of the total cases analyzed in this study, which reveals the importance of this service for clarification of the cases and its contribution to mortality statistics.

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The CARE approach to reducing diagnostic errors

Cited by 5 publications

References 11 publications

Characteristics of Medical Liability Claims Against Dermatologists From 1991 Through 2015

Characteristics of Medical Liability Claims Against Dermatologists From 1991 Through 2015

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

Estudo de casuística e concordância diagnóstica do Serviço de Verificação de Óbitos do Interior (SVOi), em Ribeirão Preto, SP, no período de 2008 a 2012

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