Lecture 12: Learning from diagnostic errors
Goal: Understand how to develop and implement a system to learn from diagnostic errors
Objectives
- Explain approaches to identifying cases with diagnostic errors
- Describe the importance of analyzing errors for contributing factors
- Discuss interventions that can reduce diagnostic errors
Recommended reading
Lecture 12 Pretest
Which of the following in NOT an effective approach to identifying diagnostic errors?
- Multidisciplinary conferences
- Radiology-Pathology correlation
- RADPEER
- Nonrandom peer review
How many hours can be worked by residents in a continuous overnight call shift before there is a statistically significant increase in diagnostic errors?
- 8
- 10
- 12
- 14
Which of the following is an effective strategy to identify contributing factors when applied to analyzing diagnostic errors?
- Failure modes and effects analysis
- Value stream mapping
- Pareto chart
- Root cause analysis
What should a radiologist do when he identifies a missed sternal fracture on a chest CT interpreted by a resident overnight, and the patient has already been discharged?
- Document the discrepancy in the final report
- Call the ER but don’t document the discrepancy in the final report to protect the resident
- Call the ER and document communication of the sternal fracture in the final report
- Send the case to the residency program director
Which of the following is a recommendation for radiologists to reduce the risk of a malpractice claim?
- Implement over-read and second-evaluation processes that occur on an ongoing basis with feedback given to radiologists
- Encourage the use of phrases such as“when appropriate” when making recommendations about follow-up imaging
- Ensure that practices are using a random peer review process such as RADPEER to document errors rates
- Avoid using teleradiology or nighthawk services to read overnight studies
Which of the following is the best criteria for identification of peritoneal metastasis in patients with ovarian cancer?
- Presence of ascites
- Parietal peritoneal thickening
- Small bowel wall thickening
- Nodular soft tissue lesion on the peritoneal surface
Which of the following strategies can be used by radiologists when they are interpreting a study and the data are not fitting together?
- Recommend another imaging study
- Consult a colleague
- Leave exam for someone else to interpret
- Follow-up case to determine if an error was made
Which of the following is a type of cognitive bias?
- Edge of the film error
- Alliterative error
- Communication error
- Perceptual error
Framing bias:
- Reflects the undue influence that an initial interpretation has on the evaluation of subsequently collected information
- Results from a tendency to be influenced by how a question is asked or how a problem is presented
- Refers to the tendency for diagnostic assessments to be unduly influenced by easily recalled experiences
- Represents the influence that one radiologist’s judgment can exert on the diagnostic thinking of another radiologist
Which of the following is a system-related cause of diagnostic error?
- Hindsight bias
- Alliterative error
- Case complexity
- Workload
Click to see answersWatch Lecture 12