Cognitive Errors and Logistical Breakdowns Contributing to Missed and Delayed Diagnoses of Breast and Colorectal Cancers: A Process Analysis of Closed Malpractice Claims
Cognitive Errors and Logistical Breakdowns Contributing to Missed and Delayed Diagnoses of Breast and Colorectal Cancers: A Process Analysis of Closed Malpractice Claims
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DOI：
10.1007/s11606-012-2107-4
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发表时间：
2012-11-01
影响因子：
5.7
通讯作者：
Studdert, David M.
中科院分区：
文献类型：
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作者：
Poon, Eric G.;Kachalia, Allen;Studdert, David M.
对56例乳腺癌和结直肠癌漏诊和延误诊断的病例（43例乳腺癌，13例结肠癌）进行了结构化分析，以确定诊断过程中发生错误的具体点。每个错误都被归类为认知错误或逻辑故障。最后，两名医生调查人员确定了防止每个病例中错误的策略。几乎所有病例都涉及一个或多个认知错误（53/56，95%），大约一半（31/56，55%）涉及逻辑故障。最容易发生认知错误的临床活动是诊断策略的选择，无论是在办公室访视期间（25/56，45%）还是在解释测试结果期间（22/50，44%）。由初级保健医生（8/29，28%）或专科医生（7/29，26%）安排随访访视特别容易发生后勤故障。在66%的病例中，遵守当前的临床指南可以防止至少一个错误，在48%的病例中，患者倡导者的帮助可以防止至少一个错误。在乳腺癌和结直肠癌的漏诊和延误诊断中，认知错误和后勤故障很常见。预防策略应侧重于确保在选择诊断策略时提高临床指南的有效性和使用，无论是在办公室访问期间还是在解释测试结果时。还应考虑便利沟通和确保进行后续访问的工具。
To erform a process analysis of missed and delayed diagnoses of breast and colorectal cancers to identify: (1) the cognitive and logistical factors that lead to these diagnostic errors, and (2) prevention strategies.Using 56 cases (43 breast, 13 colon) of missed and delayed diagnosis, we performed structured analyses to identify specific points in the diagnostic process in which errors occurred. Each error was classified as either a cognitive error or logistical breakdown. Finally, two physician-investigators identified strategies to prevent the errors in each case.Virtually all cases involved one or more cognitive errors (53/56, 95 %) and approximately half (31/56, 55 %) involved logistical breakdowns. The clinical activity most prone to cognitive error was the selection of the diagnostic strategy, both during the office visit (25/56, 45 %) and during interpretation of test results (22/50, 44 %). Arrangement of follow-up visits with a primary care physician (8/29, 28 %) or specialist physician (7/29, 26 %) were especially prone to logistical breakdowns. Adherence to current clinical guidelines could have prevented at least one error in 66 % of cases and assistance from a patient advocate could have prevented at least one error in 48 % of cases.Cognitive errors and logistical breakdowns are common among missed and delayed diagnoses of breast and colorectal cancers. Prevention strategies should focus on ensuring improving the effectiveness and use of clinical guidelines in the selection of diagnostic strategy, both during office visits and when interpreting test results. Tools to facilitate communication and to ensure that follow-up visits occur should also be considered.