Diagnostic errors have a serious impact on patient safety. Current education strategies are limited. As a result, errors are found in retrospect and are clouded by hindsight and outcome bias where it is difficult to separate a diagnostic decision from the outcome in a rational way, particularly when a patient has suffered.
A new study by scientists from the Washington University in St Louis, published in the journal Diagnosis, uses simulation scenarios to show that trauma teams and paediatric rapid response teams would benefit from additional training to improve their diagnostic skills.
Simulation eliminates patient harm
A simulation setting, in which team decision making can occur in a clinically inconsequential, learning environment, not only eliminates patient harm, but provides experiences in managing diagnostic uncertainty that improves familiarity with the diagnostic process and more importantly offers a prospective method to provide timely feedback.
Simulation is frequently used to recreate a patient care crisis so healthcare professionals can learn in an environment that broadens their experiences and eliminates the potential for patient harm.
Scenarios designed to reconstruct diagnostic uncertainty can overcome many of the limitations of current education strategies used to provide healthcare professionals experience in the diagnostic process.
Help in crisis situations
Simulation can be used to determine how teams approach diagnosis, particularly in crisis settings where teams frequently make rapid diagnoses based on ‘rules of thumb’. The assumed diagnosis and therapies that apply in some, but not all of these settings, are often life-saving.
However, in those patients that these rules do not result in the correct treatment, the outcome is much worse as a result of these shortcuts. The ability to observe a team’s approach to the diagnostic process in real-time and provide immediate feedback about performance are advantages of a simulation setting.
In the study, four scenarios were included in training that required teams to review the ‘patient’s’ diagnosis and consider alternative diagnoses.
Twenty-one trauma teams and seventeen paediatric rapid response teams managed at least one of these scenarios.
All of the teams recognized that their ‘patient’ was not responding to treatment and searched for a cause, but less than 50% of the teams established and confirmed a new diagnosis. Of the 51 scenarios that the teams managed, only 25% of the teams initiated appropriate therapy that would resolve the crisis.
A study in real time
Based on the findings in this pilot study, the majority of teams would benefit from an education intervention designed to improve their diagnostic skills. Simulation provides a method to study in real-time how individuals and teams approach the diagnostic process and overcome the limitations of retrospective approaches that are influenced by both hindsight and outcome bias.
Read the original article here