Identifying early warning signs for diagnostic errors in primary care: a qualitative study
Identifying early warning signs for diagnostic errors in primary care: a qualitative study
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DOI：
10.1136/bmjopen-2012-001539
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发表时间：
2012-01-01
期刊：
影响因子：
2.9
通讯作者：
Thompson, Matthew
中科院分区：
文献类型：
--
作者：
Balla, John;Heneghan, Carl;Thompson, Matthew
目的：我们调查初级保健咨询中诊断错误的机制，以发现可能出现错误的警告信号。我们的目标是确定与主要风险指标相关的诊断推理过程中的位置。设计：一项定性研究，使用半结构化访谈与开放式问题。设置：在英国牛津郡进行的初级保健2个月的研究。参与者：我们通过电子邮件或口头方式接触了约25名经验丰富的全科医生，15名志愿者参加了访谈，并在方便的时候提供。干预：访谈记录提供了45个错误案例。三名研究人员搜索这些独立的潜在主题，在我们的概念framework.Outcome措施：定位步骤在诊断推理过程中与主要风险的错误和检测警告信号，可以提醒临床医生增加的风险error.Results：启动和关闭的认知过程中最暴露于风险的错误。在这个过程的早期形成的认知偏差会导致最后的错误。这些警告信号可用于提醒临床医生诊断错误的风险增加。忽略红旗或关键线索是有关的过程中被偏见通过初始帧，但同样好，它可以解释由knowledge gaps.Conclusions：认知偏见开发的问题在初始框架的错误在结束的过程。我们将这些偏差称为警告信号，可以提醒临床医生诊断错误的风险增加。我们的结论是，缺乏知识可能是诊断错误的一个重要因素。减少初级保健中的诊断错误应侧重于早期和系统地识别错误，包括未遂事故，以及持续的专业发展环境，促进行动中的反思，以突出过程偏差和知识差距的可能原因。
Objective: We investigate the mechanisms of diagnostic error in primary care consultations to detect warning signs for possible error. We aim to identify places in the diagnostic reasoning process associated with major risk indicators.Design: A qualitative study using semistructured interviews with open-ended questions.Setting: A 2-month study in primary care conducted in Oxfordshire, UK.Participants: We approached about 25 experienced general practitioners by email or word of mouth, 15 volunteered for the interviews and were available at a convenient time.Intervention: Interview transcripts provided 45 cases of error. Three researchers searched these independently for underlying themes in relation to our conceptual framework.Outcome measures: Locating steps in the diagnostic reasoning process associated with major risk of error and detecting warning signs that can alert clinicians to increased risk of error.Results: Initiation and closure of the cognitive process are most exposed to risk of error. Cognitive biases developed early in the process lead to errors at the end. These warning signs can be used to alert clinicians to the increased risk of diagnostic error. Ignoring red flags or critical cues was related to processes being biased through the initial frame, but equally well, it could be explained by knowledge gaps.Conclusions: Cognitive biases developed at the initial framing of the problem relate to errors at the end of the process. We refer to these biases as warning signs that can alert clinicians to the increased risk of diagnostic error. We conclude that lack of knowledge is likely to be an important factor in diagnostic error. Reducing diagnostic errors in primary care should focus on early and systematic recognition of errors including near misses, and a continuing professional development environment that promotes reflection in action to highlight possible causes of process bias and of knowledge gaps.