The critical step to reduce diagnostic errors in medicine: addressing the limitations of human information processing

Diagnosis ◽  
2014 ◽  
Vol 1 (1) ◽  
pp. 139-141 ◽  
Author(s):  
Laura Zwaan
Keyword(s):  
Information Processing ◽  
Diagnostic Testing ◽  
Diagnostic Errors ◽  
Diagnostic Error ◽  
Human Information Processing ◽  
Process Information ◽  
Critical Step ◽  
Common Diseases ◽  
Over Time ◽  
The Way

AbstractOver the last 50 years diagnostic testing has improved dramatically and we are now able to diagnose patients faster and more precisely than ever before. However, the incidence of diagnostic errors, particularly of common diseases, has remained relatively stable over time. In this paper, I argue that the intrinsic limitations of human information processing are crucial. The way people process information has not changed over the years and is the main cause of diagnostic error. To take a decisive step forward and substantially reduce the number of diagnostic errors in medicine, we need to create an environment which takes the intrinsic limitations of in human information processing into account.

scholarly journals Use of patient complaints to identify diagnosis-related safety concerns: a mixed-method evaluation

2021 ◽  
pp. bmjqs-2020-011593
Author(s):  
Traber D Giardina ◽  
Saritha Korukonda ◽  
Umber Shahid ◽  
Viralkumar Vaghani ◽  
Divvy K Upadhyay ◽  
...  
Keyword(s):  
Medical Record ◽  
Clinical Care ◽  
Diagnostic Testing ◽  
Diagnostic Errors ◽  
Diagnostic Error ◽  
Diagnostic Process ◽  
Healthcare Organisation ◽  
Safety Concerns ◽  
Patient Complaints ◽  
Malpractice Claims

BackgroundPatient complaints are associated with adverse events and malpractice claims but underused in patient safety improvement.ObjectiveTo systematically evaluate the use of patient complaint data to identify safety concerns related to diagnosis as an initial step to using this information to facilitate learning and improvement.MethodsWe reviewed patient complaints submitted to Geisinger, a large healthcare organisation in the USA, from August to December 2017 (cohort 1) and January to June 2018 (cohort 2). We selected complaints more likely to be associated with diagnostic concerns in Geisinger’s existing complaint taxonomy. Investigators reviewed all complaint summaries and identified cases as ‘concerning’ for diagnostic error using the National Academy of Medicine’s definition of diagnostic error. For all ‘concerning’ cases, a clinician-reviewer evaluated the associated investigation report and the patient’s medical record to identify any missed opportunities in making a correct or timely diagnosis. In cohort 2, we selected a 10% sample of ‘concerning’ cases to test this smaller pragmatic sample as a proof of concept for future organisational monitoring.ResultsIn cohort 1, we reviewed 1865 complaint summaries and identified 177 (9.5%) concerning reports. Review and analysis identified 39 diagnostic errors. Most were categorised as ‘Clinical Care issues’ (27, 69.2%), defined as concerns/questions related to the care that is provided by clinicians in any setting. In cohort 2, we reviewed 2423 patient complaint summaries and identified 310 (12.8%) concerning reports. The 10% sample (n=31 cases) contained five diagnostic errors. Qualitative analysis of cohort 1 cases identified concerns about return visits for persistent and/or worsening symptoms, interpersonal issues and diagnostic testing.ConclusionsAnalysis of patient complaint data and corresponding medical record review identifies patterns of failures in the diagnostic process reported by patients and families. Health systems could systematically analyse available data on patient complaints to monitor diagnostic safety concerns and identify opportunities for learning and improvement.

Information transformation: Some missing links

2007 ◽  
Vol 26 (3) ◽  
pp. 157-172
Author(s):  
Ivan P. Vaghely ◽  
Pierre-André Julien ◽  
André Cyr
Keyword(s):  
Decision Making ◽  
Grounded Theory ◽  
Information Processing ◽  
Knowledge Creation ◽  
Best Practice ◽  
Participant Observation ◽  
Human Information Processing ◽  
Process Information ◽  
Information Transformation ◽  
Efficient Information

Using grounded theory along with participant observation and interviews the authors explore how individuals in organizations process information. They build a model of human information processing which links the cognitivist-constructionist perspective to an algorithmic-heuristic continuum. They test this model using non-parametric procedures and find interesting results showing links to efficient information processing outcomes such as contributions to decision-making, knowledge-creation and innovation. They also identify some elements of best practice by efficient human information processing individuals whom they call the “information catalysts”.

scholarly journals Mind the overlap: how system problems contribute to cognitive failure and diagnostic errors

Diagnosis ◽  
2018 ◽  
Vol 5 (3) ◽  
pp. 151-156 ◽  
Author(s):  
Ashwin Gupta ◽  
Molly Harrod ◽  
Martha Quinn ◽  
Milisa Manojlovich ◽  
Karen E. Fowler ◽  
...  
Keyword(s):  
Information Processing ◽  
Data Gathering ◽  
Diagnostic Errors ◽  
Organizational Structures ◽  
Diagnostic Error ◽  
Diagnostic Process ◽  
Cognitive Errors ◽  
Data Verification ◽  
Consulting Services ◽  
Cognitive Failure

Abstract Background Traditionally, research has examined systems- and cognitive-based sources of diagnostic error as individual entities. However, half of all errors have origins in both domains. Methods We conducted a focused ethnography of inpatient physicians at two academic institutions to understand how systems-based problems contribute to cognitive errors in diagnosis. Medicine teams were observed on rounds and during post-round work after which interviews were conducted. Field notes related to the diagnostic process and the work system were recorded, and findings were organized into themes. Using deductive content analysis, themes were categorized based on a published taxonomy to link systems-based contributions and cognitive errors such as faulty data gathering, information processing, data verification and errors associated with multiple domains. Results Observations, focus groups and interviews of 10 teams were conducted between January 2016 and April 2017. The following themes were identified: (1) challenges with interdisciplinary communication and communication within the electronic medical record (EMR) contributed to faulty data gathering; (2) organizational structures such as the operation of consulting services in silos promoted faulty information processing; (3) care handoffs led to faulty data verification and (4) interruptions, time constraints and a cluttered physical environment negatively influenced multiple cognitive domains. Conclusions Systems-based factors often facilitate and promote cognitive problems in diagnosis. Linking systems-based contributions to downstream cognitive impacts and intervening on both in tandem may help prevent diagnostic errors.

scholarly journals The challenges in defining and measuring diagnostic error

Diagnosis ◽  
2015 ◽  
Vol 2 (2) ◽  
pp. 97-103 ◽  
Author(s):  
Laura Zwaan ◽  
Hardeep Singh
Keyword(s):  
Patient Safety ◽  
Real World ◽  
Expert Panel ◽  
Diagnostic Errors ◽  
Diagnostic Error ◽  
Disease Diagnosis ◽  
International Conference ◽  
Research Challenges ◽  
Conducting Research ◽  
Over Time

AbstractDiagnostic errors have emerged as a serious patient safety problem but they are hard to detect and complex to define. At the research summit of the 2013 Diagnostic Error in Medicine 6th International Conference, we convened a multidisciplinary expert panel to discuss challenges in defining and measuring diagnostic errors in real-world settings. In this paper, we synthesize these discussions and outline key research challenges in operationalizing the definition and measurement of diagnostic error. Some of these challenges include 1) difficulties in determining error when the disease or diagnosis is evolving over time and in different care settings, 2) accounting for a balance between underdiagnosis and overaggressive diagnostic pursuits, and 3) determining disease diagnosis likelihood and severity in hindsight. We also build on these discussions to describe how some of these challenges can be addressed while conducting research on measuring diagnostic error.

scholarly journals Information processing in the European Union’s Common Fisheries Policy

2020 ◽  
pp. 1-21
Author(s):  
Sebastiaan Princen ◽  
Katrijn Siderius ◽  
Sebastián Villasante
Keyword(s):  
Information Processing ◽  
Punctuated Equilibrium ◽  
Equilibrium Theory ◽  
Punctuated Equilibrium Theory ◽  
Policy Studies ◽  
Process Information ◽  
Fish Stocks ◽  
Fisheries Policy ◽  
Fisheries Conservation ◽  
Over Time

Abstract The policy studies literature is divided on how information processing takes place in policy processes. Punctuated equilibrium theory claims that policymakers tend to process information disproportionately, giving more weight to some incoming signals than to others. By contrast, thermostatic models of policymaking argue that policymakers respond in a more proportionate way. In this paper, we analyse information processing in the adoption of Total Allowable Catches (TACs) under the European Union’s (EU) Common Fisheries Policy. Based on a novel measure for the proportionality of information processing, it shows that over time TACs have become more closely aligned with incoming signals about fish stocks. This development can be explained through a combination of changing discourses around fisheries conservation and institutional adjustments in EU fisheries policy. This analysis has implications for the debate between punctuated equilibrium and thermostatic models of policymaking and our understanding of the effectiveness of EU fisheries policies.

Individual differences and the trait of aggression

1989 ◽  
Vol 3 (2) ◽  
pp. 95-106 ◽  
Author(s):  
L. Rowell Huesmann ◽  
Leonard D. Eron
Keyword(s):  
Information Processing ◽  
Individual Differences ◽  
Life Experiences ◽  
Outcome Expectancies ◽  
Human Information Processing ◽  
Physiological Factors ◽  
Psychological Study ◽  
Associative Structure ◽  
External Cues ◽  
Over Time

Aggression, as a variable of psychological study, has the hallmarks of a deeply ingrained personality trait. It is related to genetic and physiological factors; it emerges early in life but is influenced and shaped by a chilďs life experiences; it is consistently associated with gender and is stable or predictable over time and across situations. However, it does not follow that aggression must be viewed as a drive. On the contrary, in this article we argue that aggression is best represented internally as a collection of specific 'scripts' for social behaviour, emphasizing aggressive responding, and the associative structure relating these scripts to each other, to external cues, and to outcome expectancies. The construction and maintenance of these scripts obey well‐understood principles of human information processing. Once established, these networks of scripts may be extremely resistant to change. The result is a set of cognitive structures that promote consistent forms of instrumental and hostile aggression over time and across situations.

A metatheoretical framework of diversity in teams

2016 ◽  
Vol 70 (8) ◽  
pp. 911-939 ◽  
Author(s):  
Margarita Mayo ◽  
Maria Kakarika ◽  
Charalampos Mainemelis ◽  
Nicolas Till Deuschel
Keyword(s):  
Information Processing ◽  
Theoretical Models ◽  
Social Categorization ◽  
Response Patterns ◽  
Dynamic Nature ◽  
Team Diversity ◽  
Team Success ◽  
Group Boundary ◽  
Over Time ◽  
The Way

In the last 22 years, research on diversity in teams has been propelled by information processing and social categorization theories, and more recently, by theories of disparity/(in)justice and access to external networks. These theories stress different diversity processes, treating team diversity respectively as variety of information, as separation, as disparity, and as variety of access. We appraise this literature by identifying major problems in the way these four foundational theories are used either alone or in combination, arguing that the related theoretical models are inherently incomplete and static. In an attempt to resolve these problems, we introduce a metatheoretical framework that relates these four foundational theories according to the metadimensions of group boundary and diversity mindset. We also propose a metatheoretical model that identifies interactions among the four diversity processes and specifies diversity response patterns to team success or failure over time. Our metatheoretical approach resolves significant omissions in the literature and penetrates into the dynamic nature of team diversity in more complex, temporally sensitive and synthetic ways.

Cognitive Reflection Effects on Time Discounting

2018 ◽  
Vol 39 (2) ◽  
pp. 99-106 ◽  
Author(s):  
Michał Białek ◽  
Przemysław Sawicki
Keyword(s):  
Individual Differences ◽  
Individual Difference ◽  
Delay Discounting ◽  
Reference Point ◽  
Reference Points ◽  
Cognitive Reflection Test ◽  
Process Information ◽  
Time Discounting ◽  
Cognitive Reflection ◽  
The Way

Abstract. In this work, we investigated individual differences in cognitive reflection effects on delay discounting – a preference for smaller sooner over larger later payoff. People are claimed to prefer more these alternatives they considered first – so-called reference point – over the alternatives they considered later. Cognitive reflection affects the way individuals process information, with less reflective individuals relying predominantly on the first information they consider, thus, being more susceptible to reference points as compared to more reflective individuals. In Experiment 1, we confirmed that individuals who scored high on the Cognitive Reflection Test discount less strongly than less reflective individuals, but we also show that such individuals are less susceptible to imposed reference points. Experiment 2 replicated these findings additionally providing evidence that cognitive reflection predicts discounting strength and (in)dependency to reference points over and above individual difference in numeracy.

The Type of Temperament, Mood, and Strategies of Categorization

2012 ◽  
Vol 33 (4) ◽  
pp. 227-236 ◽  
Author(s):  
Agata Wytykowska
Keyword(s):  
Information Processing ◽  
Negative Mood ◽  
Cognitive Activity ◽  
Processing Capacity ◽  
Affective Value ◽  
The Relationship ◽  
The Way

In Strelau’s theory of temperament (RTT), there are four types of temperament, differentiated according to low vs. high stimulation processing capacity and to the level of their internal harmonization. The type of temperament is considered harmonized when the constellation of all temperamental traits is internally matched to the need for stimulation, which is related to effectiveness of stimulation processing. In nonharmonized temperamental structure, an internal mismatch is observed which is linked to ineffectiveness of stimulation processing. The three studies presented here investigated the relationship between temperamental structures and the strategies of categorization. Results revealed that subjects with harmonized structures efficiently control the level of stimulation stemming from the cognitive activity, independent of the affective value of situation. The pattern of results attained for subjects with nonharmonized structures was more ambiguous: They were as good as subjects with harmonized structures at adjusting the way of information processing to their stimulation processing capacities, but they also proved to be more responsive to the affective character of stimulation (positive or negative mood).

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