Summary of "Modulo 3.1 - Error Diagnóstico"

Summary of “Modulo 3.1 - Error Diagnóstico”

This lecture addresses diagnostic errors within healthcare, emphasizing their significant impact on patient safety, clinical outcomes, and economic consequences. It is part of a quality management course module focused on reducing errors that compromise patient care.

Main Ideas and Concepts

Importance of Diagnostic Errors

Diagnostic errors are a leading cause of patient harm, disability, and death (40,000–80,000 deaths annually in the U.S.).
They are often underestimated and underreported compared to other errors like medication mistakes.
Diagnostic errors contribute to:
- 12% of adverse events,
- 10% of hospital deaths,
- 30% of malpractice lawsuits.
They undermine patient trust in healthcare systems.

Challenges in Recognizing Diagnostic Errors

Difficulty in defining and identifying diagnostic errors.
Poor outpatient documentation and fragmented care make error tracking challenging.
Diagnostic errors can be:
- Failures to diagnose,
- Misdiagnoses,
- Delays in diagnosis.
The diagnostic process is complex, involving multiple professionals and departments (labs, imaging, pathology).

Causes of Diagnostic Errors

Cognitive factors: premature closure, anchoring heuristics, confirmation bias, authority bias, and contextual pressures (e.g., flu epidemic).
Attitudinal factors: overconfidence and complacency among clinicians.
Communication factors: fragmented care, poor teamwork, lack of patient involvement, inadequate communication of results.
Systemic factors: poor working conditions, inadequate processes, failure to follow up on abnormal test results, lack of continuity of care.

Examples Highlighted

Ebola case in the U.S. where a nurse documented relevant symptoms but the physician dismissed them, leading to fatal misdiagnosis.
Misdiagnosis of appendicitis as urinary tract infection or back pain resulting in severe complications.
Overuse of diagnostic tests (e.g., thyroid ultrasounds) leading to overdiagnosis without mortality benefit.
Excessive radiation exposure in children due to unnecessary CT scans.

Modern Definition of Diagnostic Error

Beyond just labeling a disease incorrectly, it includes failure to communicate the diagnosis effectively to the patient and family.
Recognizes diagnostic process as a multi-professional, multi-step system requiring effective communication and collaboration.

Methodologies and Recommendations to Reduce Diagnostic Errors

Strengthen Safety Culture
- Promote a “just culture” that encourages reporting errors without punishment.
- Foster psychological safety so professionals can admit uncertainty or mistakes.
Team-Based Diagnostic Process
- Involve patients and families as active partners.
- Enhance intra- and interprofessional collaboration (doctors, nurses, lab techs, radiologists, pathologists).
- Use effective communication and teamwork training.
Cognitive Training
- Train clinicians to recognize and correct cognitive biases.
- Promote critical thinking and diagnostic reasoning skills.
Use of Technology and Information Systems
- Implement decision support systems and ensure interoperability of medical records.
- Develop patient portals for better access to information.
- Explore artificial intelligence to aid diagnosis.
Error Detection and Learning Systems
- Use incident reporting and feedback mechanisms.
- Conduct autopsies and double-reading of diagnostic images to identify errors.
- Encourage patient follow-up and surveys to detect diagnostic issues.
Regulatory and Economic Incentives
- Establish national safety observatories and quality agencies.
- Provide legal protections for error reporters.
- Reform tort laws to support no-fault systems.
- Align payment models to reward quality diagnostic processes, especially in primary care.
- Fund research on diagnostic errors and patient participation.
Patient and Family Engagement
- Educate patients through schools and guides on symptom recognition.
- Enable access to medical records and adverse event reporting.
- Develop self-diagnosis tools and chronic condition management guides.
Avoid Overuse of Diagnostic Tests
- Use diagnostic studies judiciously to prevent unnecessary harm and costs.
- Consult diagnostic specialists before ordering tests to optimize study selection.

Key Takeaways

Diagnostic errors are a critical but underrecognized issue in patient safety.
They result from a complex interplay of cognitive, attitudinal, communication, and systemic factors.
Solutions require cultural change, teamwork, patient involvement, technological support, and regulatory frameworks.
Overdiagnosis and unnecessary testing can paradoxically increase errors and patient harm.
Improving diagnostic accuracy is essential for reducing morbidity, mortality, and healthcare costs.

Speakers / Sources

The lecture is delivered by a single speaker identified as M. (no full name provided).
References to institutions and concepts include:
- National Institute of Health (NIH)
- Academy of Sciences
- International Patient Safety Goals
- Studies and surveys from European hospitals and U.S. healthcare data
- Darwin (quoted on confidence and ignorance)