1. What Contributes to Diagnostic Error or Delay? A Qualitative Exploration Across Diverse Acute Care Settings in the United States
- Author
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Svetlana Herasevich, Brian W. Pickering, Chanyan Huang, Jalal Soleimani, Yuliya Pinevich, Yue Dong, Ashok Kumbamu, Aaron L. Leppin, Ognjen Gajic, and Amelia Barwise
- Subjects
medicine.medical_specialty ,Consensus ,Sociotechnical system ,Leadership and Management ,MEDLINE ,Article ,03 medical and health sciences ,0302 clinical medicine ,Acute care ,medicine ,Humans ,030212 general & internal medicine ,Diagnostic Errors ,Medical diagnosis ,Qualitative Research ,Medical education ,Communication ,030503 health policy & services ,Public Health, Environmental and Occupational Health ,Focus Groups ,Moderation ,Focus group ,United States ,Conceptual framework ,0305 other medical science ,Psychology ,Qualitative research - Abstract
OBJECTIVES: Diagnostic error and delay is a prevalent and impactful problem. This study was part of a mixed methods approach to understand the organizational, clinician, and patient factors contributing to diagnostic error and delay among acutely ill patients within a health system, as well as recommendations for the development of tailored, targeted, feasible, and effective interventions. METHODS: We did a multisite qualitative study using focus group methodology to explore the perspectives of key clinician stakeholders. We used a conceptual framework that characterized diagnostic error and delay as occurring within one of three stages of the patient’s diagnostic journey –critical information gathering, synthesis of key information, and decision making and communication. We developed our moderator guide based on the sociotechnical frameworks previously described by Holden and Singh for understanding non-cognitive factors that lead to diagnostic error and delay. De-identified focus group transcripts were coded in triplicate and to consensus over a series of meetings. A final coded dataset was then uploaded into NVivo software. The data was then analyzed to generate overarching themes and categories. RESULTS: We recruited a total of 64 participants across 4 sites from emergency departments, hospital floor, and intensive care unit settings into 11 focus groups. Clinicians perceive that diverse organizational, communication and coordination, individual clinician, and patient factors interact to impede the process of making timely and accurate diagnoses. CONCLUSIONS: This study highlights the complex sociotechnical system within which individual clinicians operate and the contributions of systems, processes, and institutional factors to diagnostic error and delay.
- Published
- 2021