Interpretation of Skin Biopsies by General Pathologists: Diagnostic Discrepancy Rate Measured by Blinded Review

2003 ◽  
Vol 127 (11) ◽  
pp. 1489-1492 ◽  
Author(s):  
Martin J. Trotter ◽  
Andrea K. Bruecks
Keyword(s):  
Primary Care ◽  
Error Detection ◽  
Primary Care Physicians ◽  
False Negative ◽  
Diagnostic Error ◽  
Surgical Pathology ◽  
Total Quality ◽  
Improvement Program ◽  
Discrepancy Rate ◽  
Skin Biopsies

Abstract Context.—Slide review has been advocated as a means to reduce diagnostic error in surgical pathology and is considered an important component of a total quality assurance program. Blinded review is an unbiased method of error detection, and this approach may be used to determine the diagnostic discrepancy rates in surgical pathology. Objective.—To determine the diagnostic discrepancy rate for skin biopsies reported by general pathologists. Design.—Five hundred eighty-nine biopsies from 500 consecutive cases submitted by primary care physicians and reported by general pathologists were examined by rapid-screen, blinded review by 2 dermatopathologists, and the original diagnosis was compared with the review interpretation. Results.—Agreement was observed in 551 (93.5%) of 589 biopsies. Blinded review of these skin biopsies by experienced dermatopathologists had a sensitivity of 100% (all lesions originally reported were detected during review). False-negative errors were the most common discrepancy, but false positives, threshold discrepancies, and differences in type or grade were also observed. Only 1.4% of biopsies had discrepancies that were of potential clinical importance. Conclusions.—Blinded review demonstrates that general pathologists reporting skin biopsies submitted by primary care physicians have a low diagnostic error rate. The method detects both false-negative and false-positive cases and identifies problematic areas that may be targeted in continuing education activities. Blinded review is a useful component of a dermatopathology quality improvement program.

Checklists to prevent diagnostic errors: a pilot randomized controlled trial

Diagnosis ◽  
2015 ◽  
Vol 2 (3) ◽  
pp. 163-169 ◽  
Author(s):  
John W. Ely ◽  
Mark A. Graber
Keyword(s):  
Primary Care ◽  
Usual Care ◽  
Error Rate ◽  
Primary Care Physicians ◽  
Diagnostic Errors ◽  
Diagnostic Error ◽  
Diagnostic Process ◽  
Emergency Physicians ◽  
Mean Error ◽  
Premature Closure

AbstractMany diagnostic errors are caused by premature closure of the diagnostic process. To help prevent premature closure, we developed checklists that prompt physicians to consider all reasonable diagnoses for symptoms that commonly present in primary care.We enrolled 14 primary care physicians and 100 patients in a randomized clinical trial. The study took place in an emergency department (5 physicians) and a same-day access clinic (9 physicians). The physicians were randomized to usual care vs. diagnostic checklist. After completing the history and physical exam, checklist physicians read aloud a differential diagnosis checklist for the chief complaint. The primary outcome was diagnostic error, which was defined as a discrepancy between the diagnosis documented at the acute visit and the diagnosis based on a 1-month follow-up phone call and record review.There were 17 diagnostic errors. The mean error rate among the seven checklist physicians was not significantly different from the rate among the seven usual-care physicians (11.2% vs. 17.8%; p=0.46). In a post-hoc subgroup analysis, emergency physicians in the checklist group had a lower mean error rate than emergency physicians in the usual-care group (19.1% vs. 45.0%; p=0.04). Checklist physicians considered more diagnoses than usual-care physicians during the patient encounters (6.5 diagnoses [SD 4.2] vs. 3.4 diagnoses [SD 2.0], p<0.001).Checklists did not improve the diagnostic error rate in this study. However further development and testing of checklists in larger studies may be warranted.

scholarly journals Use of Heuristics during the clinical decision process in from family physicians in real conditions.

2021 ◽  
Author(s):  
Carmen Fernández Aguilar ◽  
José-Jesús Martín-Martín ◽  
Sergio Minué-Lorenzo ◽  
Alberto Fernández Ajuria
Keyword(s):  
Primary Care ◽  
Decision Process ◽  
Primary Care Physicians ◽  
Clinical Decision ◽  
Diagnostic Error ◽  
Operational Definition ◽  
Statistical Correlation ◽  
Diagnostic Process ◽  
Representativeness Heuristic ◽  
Definition Of

Rationale, aims and objectives: The available evidence on the existence and consequences of the use of heuristics in the clinical decision process is very scarce. The purpose of this study is to measure the use of the Representativeness, Availability and Overconfidence heuristics in real conditions with Primary Care physicians in cases of dyspnea and to study the possible correlation with diagnostic error. Methods: A prospective cohort study was carried out in 4 Primary Care centers in which 371 new cases or dyspnea were registered. The use of the three heuristics in the diagnostic process is measured through an operational definition of the same. Subsequently, the statistical correlation with the identified clinical errors is analyzed. Results: In 9.97% of the registered cases a diagnostic error was identified. In 49.59% of the cases, the physicians used the representativeness heuristic in the diagnostic decision process. The availability heuristic was used by 82.38% of the doctors and finally, in more than 50% of the cases the doctors showed excess confidence. None of the heuristics showed a statistically significant correlation with diagnostic error. Conclusion: The three heuristics have been used as mental shortcuts by Primary Care physicians in the clinical decision process in cases of dyspnea, but their influence on the diagnostic error is not significant. New studies based on the proposed methodology will allow confirming both its importance and its association with diagnostic error.

scholarly journals Incidence of Diagnostic Error in Peripheral Vascular Disease Among Primary Care Physicians

2019 ◽  
Vol 70 (4) ◽  
pp. e104
Author(s):  
Maged Metias ◽  
Jennifer Armstrong ◽  
Vikram Iyer ◽  
David Szalay ◽  
Theodore Rapanos ◽  
...  
Keyword(s):  
Primary Care ◽  
Vascular Disease ◽  
Peripheral Vascular Disease ◽  
Primary Care Physicians ◽  
Diagnostic Error ◽  
Peripheral Vascular

scholarly journals Use of Heuristics during the clinical decision process in Primary Care physicians in real conditions.

2021 ◽  
Author(s):  
Carmen Fernández Aguilar ◽  
José-Jesús Martín-Martín ◽  
Sergio Minué-Lorenzo ◽  
Miquel Farres
Keyword(s):  
Primary Care ◽  
Decision Process ◽  
Primary Care Physicians ◽  
Clinical Decision ◽  
Diagnostic Error ◽  
Operational Definition ◽  
Statistical Correlation ◽  
Diagnostic Process ◽  
Representativeness Heuristic ◽  
Definition Of

Rationale, aims and objectives: The available evidence on the existence and consequences of the use of heuristics in the clinical decision process is very scarce. The purpose of this study is to measure the use of the Representativeness, Availability and Overconfidence heuristics in real conditions with Primary Care physicians in cases of dyspnea and to study the possible correlation with diagnostic error. Methods: A prospective cohort study was carried out in 4 Primary Care centers in which 371 new cases or dyspnea were registered. The use of the three heuristics in the diagnostic process is measured through an operational definition of the same. Subsequently, the statistical correlation with the identified clinical errors is analyzed. Results: In 9.97% of the registered cases a diagnostic error was identified. In 49.59% of the cases, the physicians used the representativeness heuristic in the diagnostic decision process. The availability heuristic was used by 82.38% of the doctors and finally, in more than 50% of the cases the doctors showed excess confidence. None of the heuristics showed a statistically significant correlation with diagnostic error. Conclusion: The three heuristics have been used as mental shortcuts by Primary Care physicians in the clinical decision process in cases of dyspnea, but their influence on the diagnostic error is not significant. New studies based on the proposed methodology will allow confirming both its importance and its association with diagnostic error.

Comparing Methods to Measure Error in Gynecologic Cytology and Surgical Pathology

2006 ◽  
Vol 130 (5) ◽  
pp. 626-629 ◽  
Author(s):  
Andrew A. Renshaw
Keyword(s):  
Clinical Practice ◽  
Error Detection ◽  
Gold Standard ◽  
Diagnostic Error ◽  
Error Rates ◽  
Surgical Pathology ◽  
Measuring Error ◽  
Review Of The Literature ◽  
Actual Clinical Practice ◽  
Measure Error

Abstract Context.—Both gynecologic cytology and surgical pathology use similar methods to measure diagnostic error, but differences exist between how these methods have been applied in the 2 fields. Objective.—To compare the application of methods of error detection in gynecologic cytology and surgical pathology. Data Sources.—Review of the literature. Conclusions.—There are several different approaches to measuring error, all of which have limitations. Measuring error using reproducibility as the gold standard is a common method to determine error. While error rates in gynecologic cytology are well characterized and methods for objectively assessing error in the legal setting have been developed, meaningful methods to measure error rates in clinical practice are not commonly used and little is known about the error rates in this setting. In contrast, in surgical pathology the error rates are not as well characterized and methods for assessing error in the legal setting are not as well defined, but methods to measure error in actual clinical practice have been characterized and preliminary data from these methods are now available concerning the error rates in this setting.

Pediatric Surgical Pathology: Pitfalls and Strategies for Error Prevention

2006 ◽  
Vol 130 (5) ◽  
pp. 610-612
Author(s):  
Cheryl M. Coffin
Keyword(s):  
Quality Assurance ◽  
Error Detection ◽  
Hirschsprung Disease ◽  
Diagnostic Error ◽  
Surgical Pathology ◽  
Children's Hospitals ◽  
Children’S Hospitals ◽  
Quality Aspects ◽  
Few Data ◽  
Diagnostic Pitfalls

Abstract Context.—Few data exist regarding quality measures for pediatric surgical pathology, types of errors, or how error-prone situations and diagnostic pitfalls can be minimized. Objective.—This review reports on survey findings regarding methodology for quality assurance and error detection measurement and classification in pediatric surgical pathology. It presents information regarding, and quality aspects of, intraoperative consultations in pediatric surgical pathology. General strategies for identifying diagnostic pitfalls in pediatric surgical pathology are briefly discussed. Data Sources.—A survey of children's hospitals based on a survey created by the Association of Directors of Anatomic and Surgical Pathology, literature review, and institutional quality assurance records provided information for this review. Conclusions.—Approaches to quality assurance and error reduction in pediatric surgical pathology are similar to those used in general surgical pathology. The children's hospitals that were surveyed used a variety of standard quality assurance measures. Because of differences in data collection, classification, and reporting, it is not possible to provide a detailed analysis of the types of diagnostic error across institutions at this time. Intraoperative consultations are a potential source of error. Pediatric neoplasms and Hirschsprung disease account for the majority of intraoperative consultations in the pediatric setting. Further considerations include the unique aspects of pediatric medical and neoplastic disorders and special diagnostic criteria, classification, grading, and staging requirements.

scholarly journals Use of Heuristics during the clinical decision process from family physicians in real conditions.

2021 ◽  
Author(s):  
Carmen Fernández Aguilar ◽  
José-Jesús Martín-Martín ◽  
Sergio Minué-Lorenzo ◽  
Alberto Fernández Ajuria
Keyword(s):  
Primary Care ◽  
Decision Process ◽  
Primary Care Physicians ◽  
Clinical Decision ◽  
Diagnostic Error ◽  
Operational Definition ◽  
Statistical Correlation ◽  
Diagnostic Process ◽  
Representativeness Heuristic ◽  
Definition Of

Rationale, aims and objectives: The available evidence on the existence and consequences of the use of heuristics in the clinical decision process is very scarce. The purpose of this study is to measure the use of the Representativeness, Availability and Overconfidence heuristics in real conditions with Primary Care physicians in cases of dyspnea and to study the possible correlation with diagnostic error. Methods: A prospective cohort study was carried out in 4 Primary Care centers in which 371 new cases or dyspnea were registered. The use of the three heuristics in the diagnostic process is measured through an operational definition of the same. Subsequently, the statistical correlation with the identified clinical errors is analyzed. Results: In 9.97% of the registered cases a diagnostic error was identified. In 49.59% of the cases, the physicians used the representativeness heuristic in the diagnostic decision process. The availability heuristic was used by 82.38% of the doctors and finally, in more than 50% of the cases the doctors showed excess confidence. None of the heuristics showed a statistically significant correlation with diagnostic error. Conclusion: The three heuristics have been used as mental shortcuts by Primary Care physicians in the clinical decision process in cases of dyspnea, but their influence on the diagnostic error is not significant. New studies based on the proposed methodology will allow confirming both its importance and its association with diagnostic error.

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