Mind the overlap: how system problems contribute to cognitive failure and diagnostic errors

• DOI: 10.1515/dx-2018-0014
• Publication Date: 2018-07-16T07:49:29Z
• Authors: Ashwin Gupta; Molly Harrod; Martha Quinn; Milisa Manojlovich; Karen E. Fowler; Hardeep Singh; Sanjay Saint; Vineet Chopra
• Keywords: 2. Zero hunger; Inpatients; Health informatics and information systems; Medical Errors; Data Collection; Clinical Decision-Making; Observation; diagnostic error; Focus Groups; Health policy; 3. Good health; 03 medical and health sciences; Cognition; 0302 clinical medicine; systems-related error; Physicians; Humans; Hospital Communication Systems; Diagnostic Errors; cognitive error; Anthropology, Cultural

Abstract Background Traditionally, research has examined systems- and cognitive-based sources of diagnostic error as individual entities. However, half all errors have origins in both domains. Methods We conducted a focused ethnography inpatient physicians at two academic institutions to understand how systems-based problems contribute cognitive diagnosis. Medicine teams were observed on rounds during post-round work after which interviews conducted. Field notes related the process system recorded, findings organized into themes. Using deductive content analysis, themes categorized based published taxonomy link contributions such faulty data gathering, information processing, verification associated with multiple Results Observations, focus groups 10 between January 2016 April 2017. The following identified: (1) challenges interdisciplinary communication within electronic medical record (EMR) contributed gathering; (2) organizational structures operation consulting services silos promoted processing; (3) care handoffs led (4) interruptions, time constraints cluttered physical environment negatively influenced Conclusions Systems-based factors often facilitate promote Linking downstream impacts intervening tandem may help prevent errors.