RT Journal Article
T1 Identification of factors associated with diagnostic error in primary care.
A1 Minué, Sergio
A1 Bermúdez-Tamayo, Clara
A1 Fernández, Alberto
A1 Martín-Martín, José Jesús
A1 Benítez, Vivian
A1 Melguizo, Miguel
A1 Caro, Araceli
A1 Orgaz, María José
A1 Prados, Miguel Angel
A1 Díaz, José Enrique
A1 Montoro, Rafael
K1 Primary care
K1 Diagnostic errors
K1 Decision-making
K1 Diagnóstico Diferencial
K1 Errores Diagnósticos
K1 Disnea
K1 Femenino
K1 Investigación sobre Servicios de Salud
K1 Humanos
K1 Masculino
K1 Atención Primaria de Salud
K1 Estudios Prospectivos
K1 Cuestionarios
K1 Proyectos de Investigación
K1 España
AB BACKGROUNDMissed, 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.METHODSCohort 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.DISCUSSIONThis 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.
PB BioMed Central
YR 2014
FD 2014-05-12
LK http://hdl.handle.net/10668/1878
UL http://hdl.handle.net/10668/1878
LA en
NO Minué S, Bermúdez-Tamayo C, Fernández A, Martín-Martín JJ, Benítez V, Melguizo M, et al. Identification of factors associated with diagnostic error in primary care. BMC Fam Pract 2014; 15:92
NO Journal Article; Research Support, Non-U.S. Gov't;
DS RISalud
RD Apr 13, 2025