Critical care clinics
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Epidemiologic studies of diagnostic error in the intensive care unit (ICU) consist mostly of descriptive autopsy series. In these studies, rates of diagnostic errors are approximately 5% to 10%. ⋯ These alternative measurement strategies have yielded similar estimates for the frequency of diagnostic error in the ICU. Although there is a fair understanding of the frequency of errors, further research is needed to better define the risk factors for diagnostic error in the ICU.
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Clinical reasoning is prone to errors in judgment. Error is comprised of 2 components-bias and noise; each has an equally important role in the promulgation of error. Biases or systematic errors in reasoning are the product of misconceptions of probability and statistics. ⋯ Familiarity with these mathematical concepts will likely enhance clinical reasoning. Noise is defined as inter or intraobserver variability in judgment that should be identical. Guidelines in medicine are a technique to reduce noise.
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Critical care clinics · Jan 2022
ReviewA Research Agenda for Diagnostic Excellence in Critical Care Medicine.
Diagnosing critically ill patients in the intensive care unit is difficult. As a result, diagnostic errors in the intensive care unit are common and have been shown to cause harm. ⋯ However, much work remains to fully elucidate the diagnostic process in critical care. To achieve diagnostic excellence, interdisciplinary research is needed, adopting a balanced strategy of continued biomedical discovery while addressing the complex care delivery systems underpinning the diagnosis of critical illness.
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Critical care settings are unpredictable, dynamic environments where clinicians face high decision density in suboptimal conditions (stress, time constraints, competing priorities). Experts have described two systems of human decision making: one fast and intuitive; the other slow and methodical. ⋯ Heuristics are also prone to failures, or cognitive biases, which can lead to diagnostic errors. A variety of strategies have been proposed to mitigate biases; however, current understanding of such interventions to optimize diagnostic safety is still incomplete.
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Diagnostic errors remain relatively understudied and underappreciated. They are particularly concerning in the intensive care unit, where they are more likely to result in harm to patients. There is a lack of consensus on the definition of diagnostic error, and current methods to quantify diagnostic error have numerous limitations as noted in the sentinel report by the National Academy of Medicine. Although definitive definition and measurement remain elusive goals, increasing our understanding of diagnostic error is crucial if we are to make progress in reducing the incidence and harm caused by errors in diagnosis.