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Copyright This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose. Impact of a Web-based Diagnosis Reminder System on Errors of Diagnosis a Department of Health Evaluation Sciences, University of Virginia Health System, Charlottesville, VA, USA b Department of Pediatrics, University of Virginia Health System, Charlottesville, VA, USA Abstract A large number of medical errors can be attributed to errors in diagnosis. A diagnosis reminder system such as Isabel may lessen the risk of diagnostic error by providing a checklist of possible diagnoses. For this project, resident physicians used Isabel to work through a set of six simulated patient cases. The system had a positive effect on the mean diagnostic quality score and the number of clinically important diagnoses included in the differential. Introduction Errors related to diagnosis account for 26–78% of identified medical errors [1]. The most common cause of diagnostic error is failure to consider reasonable alternatives after an initial diagnosis has been reached (premature closure) [2]. A diagnosis reminder system can provide a checklist of possible diagnoses, complementing the initial differential diagnosis and lessening the risk of premature diagnostic closure. Isabel is a Web-based pediatric diagnosis reminder system. Using unstructured language, clinicians enter a list of clinical features and Isabel provides a list of relevant diagnoses. The objective of this project was to determine whether the Isabel diagnosis reminder system reduces diagnostic omissions. Methods Resident physicians were presented with a set of six simulated cases of differing difficulty. For each case, participants developed a list of likely diagnoses and a management plan before and after using the Isabel system. A panel of three expert pediatric clinicians scored the quality of responses. Primary outcome measures were a change in the number of clinically important diagnoses included in the differential diagnosis, and changes in a previously validated diagnostic quality score (DQS) and management quality score (MQS). Results 16 pediatric, 7 family medicine, and 2 emergency medicine residents participated in the study. All 25 residents completed all six cases. In 15 of the 150 cases completed (10%), Isabel caused the user to include a major diagnosis they had not considered and should have. The mean diagnostic quality score (DQS) increased significantly after residents consulted the Isabel system (0.028 + 0.008, 95% CI 0.020 – 0.036, p<0.001). We were unable to detect a difference in the management quality score (MQS). When they were surveyed, 60% of users agreed or strongly agreed that the Isabel system provided useful information and nearly 100% reported the system was easy or very easy to use. Conclusions By providing a checklist of likely diagnoses, a web-based diagnosis reminder system reduced diagnostic omissions by residents for a set of simulated cases. Incorporating this type of system into clinical practice may decrease the number of medical errors. References 1. Sandars J, Esmail A. The frequency and nature of medical error in primary care: understanding the diversity across studies. Fam Pract. 2003 Jun;20(3):231–236. [PubMed] 2. Graber ML, Franklin N, Gordon R. Diagnostic error in internal medicine. Arch Intern Med. 2005 Jul 11;165(13):1493–1499. [PubMed] |
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Fam Pract. 2003 Jun; 20(3):231-6.
[Fam Pract. 2003]