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01.12.2014 | Study protocol | Ausgabe 1/2014 Open Access

BMC Family Practice 1/2014

Identification of factors associated with diagnostic error in primary care

Zeitschrift:
BMC Family Practice > Ausgabe 1/2014
Autoren:
Sergio Minué, Clara Bermúdez-Tamayo, Alberto Fernández, José Jesús Martín-Martín, Vivian Benítez, Miguel Melguizo, Araceli Caro, María José Orgaz, Miguel Angel Prados, José Enrique Díaz, Rafael Montoro
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1471-2296-15-92) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

SM directed the study design process, planned the review and adaptation, drafted the manuscript and wrote the final version. CB participated in the study conception and design, revised the draft manuscript and critically revised the manuscript. AF participated in the study conception and design, revised the draft manuscript and critically revised the manuscript. JJM supervised the study protocol and its design, and critically revised the final manuscript. VB performed the bibliographical review and participated in the design of the audit. MM participated in the study conception, reviewed the design and implementation of the audit, and participated in the design of the dyspnoea protocol and the evaluation questionnaire. AC participated in the study design. MJO reviewed the design and implementation of the audit, and participated in the design of the dyspnoea protocol and the evaluation questionnaire. MAP reviewed the design and implementation of the audit, and participated in the design of the dyspnoea protocol and the evaluation questionnaire. JED reviewed the design and implementation of the audit, and participated in the design of the dyspnoea protocol and the evaluation questionnaire. RM reviewed the design of the initial project. All the authors revised the final version of the manuscript. All authors read and approved the final manuscript.

Abstract

Background

Missed, delayed or incorrect diagnoses are considered to be diagnostic errors. The aim of this paper is to describe the methodology of a study to analyse cognitive aspects of the process by which primary care (PC) physicians diagnose dyspnoea. It examines the possible links between the use of heuristics, suboptimal cognitive acts and diagnostic errors, using Reason’s taxonomy of human error (slips, lapses, mistakes and violations). The influence of situational factors (professional experience, perceived overwork and fatigue) is also analysed.

Methods

Cohort study of new episodes of dyspnoea in patients receiving care from family physicians and residents at PC centres in Granada (Spain). With an initial expected diagnostic error rate of 20%, and a sampling error of 3%, 384 episodes of dyspnoea are calculated to be required. In addition to filling out the electronic medical record of the patients attended, each physician fills out 2 specially designed questionnaires about the diagnostic process performed in each case of dyspnoea. The first questionnaire includes questions on the physician’s initial diagnostic impression, the 3 most likely diagnoses (in order of likelihood), and the diagnosis reached after the initial medical history and physical examination. It also includes items on the physicians’ perceived overwork and fatigue during patient care. The second questionnaire records the confirmed diagnosis once it is reached. The complete diagnostic process is peer-reviewed to identify and classify the diagnostic errors. The possible use of heuristics of representativeness, availability, and anchoring and adjustment in each diagnostic process is also analysed. Each audit is reviewed with the physician responsible for the diagnostic process. Finally, logistic regression models are used to determine if there are differences in the diagnostic error variables based on the heuristics identified.

Discussion

This work sets out a new approach to studying the diagnostic decision-making process in PC, taking advantage of new technologies which allow immediate recording of the decision-making process.
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