Diagnostic error is increasingly recognised as a significant problem - PowerPoint PPT Presentation

Take 2 – Think, Do 2 minutes to confirm your diagnosis, double check or ask for a second opinion Tracy Clarke Deputy Director Governance and Assurance

Diagnostic error is increasingly recognised as a significant problem globally • Analysis of diagnostic error in NSW has included – IIMS data for 2012 and 2013 – RCAs for 2012 – 2014 – CHASM for 2011 – 2013

Harm to patients What we know • There are patient deaths in NSW a directly attributable to a diagnostic error • Error occurs across all clinical groups What we don’t know • What is the degree of inconvenience and minimal harm to patients • The degree of impact on time to treatment / progression of disease / length of stay • What is the overall cost to health care in NSW?

Why diagnostic errors occur • System 1 Vs System 2 thinking • Red flags / pattern recognition aren’t perfect • Easy to unconsciously shift into intuitive /fast thinking: – Fatigue - 30% decrease in cognition at end of a night shift – Cognitive overload – Task interruption – Sick, depressed, angry • JMOs don’t have well developed red flag system – Junior staff need to be taught to be in slow thinking lane most of the time (Pat Crosskerry “The Importance of Cognitive Errors in Diagnosis and Strategies to Minimize Them”)

The CEC program AW

Take 2 – Think, Do To support accurate diagnostic decision making in busy clinical environments by promoting a quick reflection on the diagnostic process and enhancing recognition of high risk situations where a closer examination of the information available is warranted

Outcomes Take 2 minutes to deliberate the diagnosis • The worst case scenario is ruled out Think about situations when it may be necessary While deliberating the • Atypical or rare to take a closer look or re-evaluate the diagnosis diagnosis: presentations are identified Do something to take a • Document the • There is a high suspicion for Take a closer look when: differential diagnoses closer look and review the repeat presentations There are risk factors impacting diagnosis diagnostic decision making: • • Detect any ‘red flag’ Diagnosis is re-evaluated HALT (Hungry, Angry, Late, Tired) symptoms • Strategies to review and when things aren’t quite Cognitive biases (e.g. context, • challenge the diagnosis: right • Acknowledge framing bias) • uncertainty in Patient engagement difficulties • Individual strategies The patient and carers’ • Knowledge deficit or workload diagnostic dilemmas concerns are heard and • eg. Diagnostic Time- pressures acknowledged out • Rule out the worst Facility or specialty specific high risk • Locally identified high-risk case scenario • Team based strategies presentations - Take 2 for you patient groups are eg. Red Team Blue • Identify when recognised Team Challenge Take time to review at specific something isn’t quite • There is an environment that patient journey checkpoints: right • Seek a second opinion enables discussion around • Things aren't going as planned • Refer to specialist diagnosis • The patient is deteriorating services • The expected response to • There is appropriate referral treatment is not achieved • Escalate care for senior and escalation for diagnostic • At handover between teams medical officer dilemmas and discharge from care evaluation and input • There is effective The patient or carer is expressing • communication when concern over the diagnosis transferring care

Outcomes Take 2 minutes to deliberate the diagnosis • The worst case scenario is ruled out Think about situations when it may be necessary While deliberating the • Atypical or rare to take a closer look or re-evaluate the diagnosis diagnosis: presentations are identified Do something to take a • Document the • There is a high suspicion for Take a closer look when: differential diagnoses closer look and review the repeat presentations There are risk factors impacting diagnosis diagnostic decision making: • • Detect any ‘red flag’ Diagnosis is re-evaluated HALT (Hungry, Angry, Late, Tired) symptoms • Strategies to review and when things aren’t quite Cognitive biases (e.g. context, • challenge the diagnosis: right • Acknowledge framing bias) • uncertainty in Patient engagement difficulties • Individual strategies The patient and carers’ • Knowledge deficit or workload diagnostic dilemmas concerns are heard and • eg. Diagnostic Time- pressures acknowledged out • Rule out the worst Facility or specialty specific high risk • Locally identified high-risk case scenario • Team based strategies presentations - Take 2 for you patient groups are eg. Red Team Blue • Identify when recognised Team Challenge Take time to review at specific something isn’t quite • There is an environment that patient journey checkpoints: right • Seek a second opinion enables discussion around • Things aren't going as planned • Refer to specialist diagnosis • The patient is deteriorating services • The expected response to • There is appropriate referral treatment is not achieved • Escalate care for senior and escalation for diagnostic • At handover between teams medical officer dilemmas and discharge from care evaluation and input • There is effective The patient or carer is expressing • communication when concern over the diagnosis transferring care

Outcomes Take 2 minutes to deliberate the diagnosis • The worst case scenario is ruled out Think about situations when it may be necessary While deliberating the • Atypical or rare to take a closer look or re-evaluate the diagnosis diagnosis: presentations are identified Do something to take a • Document the • There is a high suspicion for Take a closer look when: differential diagnoses closer look and review the repeat presentations There are risk factors impacting diagnosis diagnostic decision making: • • Detect any ‘red flag’ Diagnosis is re-evaluated HALT (Hungry, Angry, Late, Tired) symptoms • Strategies to review and when things aren’t quite Cognitive biases (e.g. context, • challenge the diagnosis: right • Acknowledge framing bias) • uncertainty in Patient engagement difficulties • Individual strategies The patient and carers’ • Knowledge deficit or workload diagnostic dilemmas concerns are heard and • eg. Diagnostic Time- pressures acknowledged out • Rule out the worst Facility or specialty specific high risk • Locally identified high-risk case scenario • Team based strategies presentations - Take 2 for you patient groups are eg. Red Team Blue • Identify when recognised Team Challenge Take time to review at specific something isn’t quite • There is an environment that patient journey checkpoints: right • Seek a second opinion enables discussion around • Things aren't going as planned • Refer to specialist diagnosis • The patient is deteriorating services • The expected response to • There is appropriate referral treatment is not achieved • Escalate care for senior and escalation for diagnostic • At handover between teams medical officer dilemmas and discharge from care evaluation and input • There is effective The patient or carer is expressing • communication when concern over the diagnosis transferring care

Outcomes Take 2 minutes to deliberate the diagnosis • The worst case scenario is ruled out Think about situations when it may be necessary While deliberating the • Atypical or rare to take a closer look or re-evaluate the diagnosis diagnosis: presentations are identified Do something to take a • Document the • There is a high suspicion for Take a closer look when: differential diagnoses closer look and review the repeat presentations There are risk factors impacting diagnosis diagnostic decision making: • • Detect any ‘red flag’ Diagnosis is re-evaluated HALT (Hungry, Angry, Late, Tired) symptoms • Strategies to review and when things aren’t quite Cognitive biases (e.g. context, • challenge the diagnosis: right • Acknowledge framing bias) • uncertainty in Patient engagement difficulties • Individual strategies The patient and carers’ • Knowledge deficit or workload diagnostic dilemmas concerns are heard and • eg. Diagnostic Time- pressures acknowledged out • Rule out the worst Facility or specialty specific high risk • Locally identified high-risk case scenario • Team based strategies presentations - Take 2 for you patient groups are eg. Red Team Blue • Identify when recognised Team Challenge Take time to review at specific something isn’t quite • There is an environment that patient journey checkpoints: right • Seek a second opinion enables discussion around • Things aren't going as planned • Refer to specialist diagnosis • The patient is deteriorating services • The expected response to • There is appropriate referral treatment is not achieved • Escalate care for senior and escalation for diagnostic • At handover between teams medical officer dilemmas and discharge from care evaluation and input • There is effective The patient or carer is expressing • communication when concern over the diagnosis transferring care