None listed
Conditions
Brief summary
Errors in diagnosis, including delays and receiving an incorrect diagnosis, have serious consequences for patient safety and patient outcomes. Whilst system factors play a role in diagnostic errors, cognitive biases have been identified as being a significant contributor to diagnostic error. Evidence suggests that to address cognitive bias in diagnostic decision-making, getting a second opinion and asking questions designed to challenge bias may be effective at reducing diagnostic error. The purpose of this project is to address cognitive bias in diagnostic decision-making in Emergency Departments (ED). To do this, an intervention will be trialled which involves performing a second independent review of all abdominal pain cases presenting to Box Hill Hospital Emergency Department, followed by a structured discussion to prompt questions, broaden thinking and challenge assumptions. Following the first clinician’s assessment, an independent review will be conducted by a second clinician in the ED followed by a structured discussion between the first clinician and the second opinion. The second part of this intervention, the structured discussion, will be guided by a standard set of questions. Existing ED practices typically involve repeated ad hoc clinical examination by multiple clinicians, so it is anticipated that patients presenting to the ED with abdominal pain will not notice a change in their care, or find this process burdensome. References Blumenthal-Barby, J., & Krieger, H. (2014). Cognitive biases and heuristics in medical decision making: A critical review using a systematic search strategy. Medical Decision Making, 35(4), 539-557. Croskerry. (2003). The importance of cognitive errors in diagnosis and strategies to minimize them. Academic medicine, 78(8), 775-780. Graber, M. L., Franklin, N., & Gordon, R. (2005). Diagnostic error in internal medicine. Arch Intern Med, 165(13), 1493-1499.
Interventions
The purpose of this project is to address cognitive bias in diagnostic decision-making in Emergency Departments (ED). To do this, an intervention will be implemented for a 4-week period which involves performing a second independent review of all abdominal pain cases presenting to Box Hill Hospital Emergency Department, followed by a short (approx 3-5 minute) structured discussion to prompt questions, broaden thinking and challenge assumptions.
After the first clinician’s assessment, an indepe
The purpose of this project is to address cognitive bias in diagnostic decision-making in Emergency Departments (ED). To do this, an intervention will be implemented for a 4-week period which involves performing a second independent review of all abdominal pain cases presenting to Box Hill Hospital Emergency Department, followed by a short (approx 3-5 minute) structured discussion to prompt questions, broaden thinking and challenge assumptions. After the first clinician’s assessment, an independent review will be conducted by a second clinician in the ED, followed by a face-to-face structured discussion between the first clinician and the second clinician. The clinicians involved will be doctors (ranging from interns to consultants). The structured discussion will be guided by the following set of questions, which will be provided to clinicians on a paper form for each patient: a. What else could this be? b. Are there any symptoms or signs that don't fit? Any red flags? c. Are any additional tests/investigations needed or do you already have sufficient confidence in the diagnosis to proceed without them? d. Do we have all the relevant information about the patient? The intervention will be introduced to ED doctors by two senior Box Hill Hospital ED doctors and several university academics involved in designing the trial. This introduction will include a lunchtime launch event, along with emails and other communications to ensure all doctors at the hospital are trained in when and how to complete a RaDD during the trial period. Adherence to the intervention will be monitored by using a case report sheet that will completed each time a RaDD is performed and left in a collection box within the ED.
Sponsors
Monash University
Study design
Allocation
Non-randomised trial
Intervention model
Parallel
Primary purpose
Diagnosis
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Participants will be included if they are a clinician treating a patient presenting to one of the three Eastern Health Emergency Departments with abdominal pain as the main presenting symptom as recorded by the triage nurse.
Exclusion criteria
There are no exclusion criteria for ED clinicians.
Outcome results
None listed