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Linzer M, Sullivan EE, Olson APJ, Khazen M, Mirica M, Schiff GD. Improving diagnosis: adding context to cognition. Diagnosis (Berl) 2023; 10:4-8. [PMID: 35985033 DOI: 10.1515/dx-2022-0058] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 07/26/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND The environment in which clinicians provide care and think about their patients is a crucial and undervalued component of the diagnostic process. CONTENT In this paper, we propose a new conceptual model that links work conditions to clinician responses such as stress and burnout, which in turn impacts the quality of the diagnostic process and finally patient diagnostic outcomes. The mechanism for these interactions critically depends on the relationship between working memory (WM) and long-term memory (LTM), and ways WM and LTM interactions are affected by working conditions. SUMMARY We propose a conceptual model to guide interventions to improve work conditions, clinician reactions and ultimately diagnostic process, accuracy and outcomes. OUTLOOK Improving diagnosis can be accomplished if we are able to understand, measure and increase our knowledge of the context of care.
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Affiliation(s)
- Mark Linzer
- Department of Medicine and the Institute for Professional Worklife, Hennepin Healthcare and University of Minnesota Medical School, Minneapolis, MN, USA
| | - Erin E Sullivan
- Harvard Medical School, Center for Primary Care, Harvard University, Boston, MA, USA.,Sawyer School of Business, Suffolk University, Boston, MA, USA
| | - Andrew P J Olson
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Maram Khazen
- Harvard Medical School, Center for Primary Care, Harvard University, Boston, MA, USA.,Brigham and Women's Hospital, Center for Patient Safety Research, Boston, MA, USA.,School of Public Health, Haifa University, Haifa, Israel
| | - Maria Mirica
- Brigham and Women's Hospital, Center for Patient Safety Research, Boston, MA, USA
| | - Gordon D Schiff
- Harvard Medical School, Center for Primary Care, Harvard University, Boston, MA, USA.,Brigham and Women's Hospital, Center for Patient Safety Research, Boston, MA, USA
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Giardina TD, Shahid U, Mushtaq U, Upadhyay DK, Marinez A, Singh H. Creating a Learning Health System for Improving Diagnostic Safety: Pragmatic Insights from US Health Care Organizations. J Gen Intern Med 2022; 37:3965-3972. [PMID: 35650467 PMCID: PMC9640494 DOI: 10.1007/s11606-022-07554-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 03/30/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To identify challenges and pragmatic strategies for improving diagnostic safety at an organizational level using concepts from learning health systems METHODS: We interviewed 32 safety leaders across the USA on how their organizations approach diagnostic safety. Participants were recruited through email and represented geographically diverse academic and non-academic settings. The interview included questions on culture of reporting and learning from diagnostic errors; data gathering and analysis activities; diagnostic training and educational activities; and engagement of clinical leadership, staff, patients, and families in diagnostic safety activities. We conducted an inductive content analysis of interview transcripts and two reviewers coded all data. RESULTS Of 32 participants, 12 reported having a specific program to address diagnostic errors. Multiple barriers to implement diagnostic safety activities emerged: serious concerns about psychological safety associated with diagnostic error; lack of infrastructure for measurement, monitoring, and improvement activities related to diagnosis; lack of leadership investment, which was often diverted to competing priorities related to publicly reported measures or other incentives; and lack of dedicated teams to work on diagnostic safety. Participants provided several strategies to overcome barriers including adapting trigger tools to identify safety events, engaging patients in diagnostic safety, and appointing dedicated diagnostic safety champions. CONCLUSIONS Several foundational building blocks related to learning health systems could inform organizational efforts to reduce diagnostic error. Promoting an organizational culture specific to diagnostic safety, using science and informatics to improve measurement and analysis, leadership incentives to build institutional capacity to address diagnostic errors, and patient engagement in diagnostic safety activities can enable progress.
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Affiliation(s)
- Traber D Giardina
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt) (152), Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC), Houston, TX, USA.
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
| | - Umber Shahid
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt) (152), Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC), Houston, TX, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Umair Mushtaq
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt) (152), Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC), Houston, TX, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Divvy K Upadhyay
- Division of Quality, Safety and Patient Experience, Geisinger, Danville, PA, USA
| | - Abigail Marinez
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt) (152), Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC), Houston, TX, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Hardeep Singh
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt) (152), Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC), Houston, TX, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
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