EGUICRFU
type: UserItem
resource: Factors predicting a change in diagnosis in patients hospitalised through the emergency room: a prospective observational study
tagged: UserTag
  label: *Clinical Decision-Making
tagged: UserTag
  label: *Diagnostic Errors
tagged: UserTag
  label: *Emergency Medicine
tagged: UserTag
  label: *Emergency Service, Hospital
tagged: UserTag
  label: Diagnostic decision making
tagged: UserTag
  label: Humans
tagged: UserTag
  label: Patient Admission
tagged: UserTag
  label: Prospective Studies
tagged: UserTag
  label: Research Design
tagged: UserTag
  label: Self Efficacy
tagged: UserTag
  label: diagnostic error
tagged: UserTag
  label: patient safety

Factors predicting a change in diagnosis in patients hospitalised through the emergency room: a prospective observational study
type: AcademicArticle
abstract: INTRODUCTION: Emergency rooms (ERs) generally assign a preliminary diagnosis to patients, who are then hospitalised and may subsequently experience a change in their lead diagnosis (cDx). In ERs, the cDx rate varies from around 15% to more than 50%. Among the most frequent reasons for diagnostic errors are cognitive slips, which mostly result from faulty data synthesis. Furthermore, physicians have been repeatedly found to be poor self-assessors and to be overconfident in the quality of their diagnosis, which limits their ability to improve. Therefore, some of the clinically most relevant research questions concern how diagnostic decisions are made, what determines their quality and what can be done to improve them. Research that addresses these questions is, however, still rare. In particular, field studies that allow for generalising findings from controlled experimental settings are lacking. The ER, with its high throughput and its many simultaneous visits, is perfectly suited for the study of factors contributing to diagnostic error. With this study, we aim to identify factors that allow prediction of an ER's diagnostic performance. Knowledge of these factors as well as of their relative importance allows for the development of organisational, medical and educational strategies to improve the diagnostic performance of ERs. METHODS AND ANALYSIS: We will conduct a field study by collecting diagnostic decision data, physician confidence and a number of influencing factors in a real-world setting to model real-world diagnostic decisions and investigate the adequacy, validity and informativeness of physician confidence in these decisions. We will specifically collect data on patient, physician and encounter factors as predictors of the dependent variables. Statistical methods will include analysis of variance and a linear mixed-effects model. ETHICS AND DISSEMINATION: The Bern ethics committee approved the study under KEK Number 197/15. Results will be published in p…
pages: e011585
doi: 10.1136/bmjopen-2016-011585
source: 27169743
creator: Person
author list: Person
is part of: Issue
  date: 2016-05-14
  volume: 6
  issue: 5
  is part of: BMJ Open
    type: Journal
    issn: 2044-6055 (Electronic) 2044-6055 (Linking)

Person
given name: S. C.
surname: Hautz

Person
given name: L.
surname: Schuler

Person
given name: J. E.
surname: Kammer

Person
given name: S. K.
surname: Schauber

Person
given name: M. E.
surname: Ricklin

Person
given name: T. C.
surname: Sauter

Person
given name: V.
surname: Maier

Person
given name: T.
surname: Birrenbach

Person
given name: A.
surname: Exadaktylos

Person
given name: W. E.
surname: Hautz