Grand Rounds - Dr. Heather Murray - Diagnostic error in the ED - Lets talk about it

In this episode, Dr. Heather Murray, from Queen's University Department of Emergency Medicine presents the landscape of diagnostic errors in emergency medicine from the perspective of why they might occur, what can be done when they happen, and how we might minimize them in the future. 

 

CONTACTS

X - @AlwaysOnEM; @VenkBellamkonda

YouTube - @AlwaysOnEM; @VenkBellamkonda

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

Email - [email protected]

 

REFERENCES

ARHQ report and responses:

• December 2022, AHRQ (Agency for Healthcare Research and Quality) released a systematic review on diagnostic error in the ED. https://effectivehealthcare.ahrq.gov/sites/default/files/related_files/cer-258-diagnostic-errors.pdf
• Letter from many ED organizations: Multi-Organizational Letter Regarding AHRQ Report on Diagnostic Errors in the Emergency Department December 14, 2022
• Published critical appraisal of report: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10121120/pdf/ms120_p0114.pdf
• JAMA commentary Feb 2023 “Misdiagnosis in the ED: Time for a System Solution” Misdiagnosis in the Emergency Department: Time for a System Solution | Health Care Safety | JAMA

Recovering from error:

• ARHQ summary on recovery after error Second Victims: Support for Clinicians Involved in Errors and Adverse Events | PSNet
• ARHQ Commentary – after error:How Do Providers Recover From Errors? | PSNet
• Clinician Peer Support Program after adverse events – implementation Supporting Clinicians after Adverse Events: Development of a Clinician Peer Support Program - PMC
• Scott SD, Hirschinger LE, Cox KR, McCoig M, Hahn-Cover K, Epperly KM, Phillips EC, Hall LW. Caring for our own: deploying a systemwide second victim rapid response team. Jt Comm J Qual Patient Saf. 2010 May;36(5):233-40. Caring for our own: deploying a systemwide second victim rapid response team

 

General resources on Diagnostic Error:

• Schiff JAMA Network Open 2021Characteristics of Disease-Specific and Generic Diagnostic Pitfalls: A Qualitative Study | Health Policy | JAMA Network Open
• Monteiro et al. 2020 Review “The enduring myth of generalisable skills.” https://asmepublications.onlinelibrary.wiley.com/doi/full/10.1111/medu.13872
• Book – Improving Diagnosis in Health Care (chapter 9) The Path to Improve Diagnosis and Reduce Diagnostic Error

 

Cognitive biases:

• MDs were asked to reflect on a serious error and given some education on cognitive biases: Watari, T.; Tokuda, Y.; Amano, Y.; Onigata, K.; Kanda, H. Cognitive Bias and Diagnostic Errors among Physicians in Japan: A Self Reflection Survey. Int. J. Environ. Res. Public Health 2022, 19, 4645. Cognitive Bias and Diagnostic Errors among Physicians in Japan: A Self-Reflection Survey
• Anchoring Bias and strategies for overcoming: Anchoring Bias With Critical Implications | PSNet
• "Give me a break!" A systematic review and meta-analysis on the efficacy of micro-breaks for increasing well-being and performance: Albulescu P, Macsinga I, Rusu A, Sulea C, Bodnaru A, et al. (2022) "Give me a break!" A systematic review and meta-analysis on the efficacy of micro-breaks for increasing well-being and performance. PLOS ONE 17(8): e0272460. "Give me a break!" A systematic review and meta-analysis on the efficacy of micro-breaks for increasing well-being and performance | PLOS ONE

 

Better teams in EM:

• Purdy E, Borchert L, El-Bitar A et al “Psychological safety and Emergency Medicine team performance: a mixed methods review.” EM Australasia 2023;35:456-465 Psychological safety and emergency department team performance: A mixed‐methods study - Purdy
• Ottawa M+M rounds framework: Enhancing the Quality of Morbidity and Mortality Rounds: The Ottawa M&M Model - Calder - 2014 - Academic Emergency Medicine - Wiley Online Library

 

Selected references for artificial intelligence in medicine:

• AI chatbot in JAMA Internal Medicine Comparing Physician and Artificial Intelligence Chatbot Responses to Patient Questions Posted to a Public Social Media Forum | Health Informatics | JAMA Internal Medicine
• AI in Health Care NEJM podcast Is Medicine Ready for AI? — ITT Episode 6 | NEJM
• AI clinical prediction (systematic review 2022) Artificial Intelligence for the Prediction of In-Hospital Clinical Deterioration: A Systematic Review - PMC
• Lee P, Bubeck S, Petro J. Benefits, limits and risks of GPT-4 as an AI chatbot for medicine. NEJM 2023;388:1233-1239 Benefits, Limits, and Risks of GPT-4 as an AI Chatbot for Medicine | NEJM