ArticleBMC medical informatics and decision making2006
Assessment of the potential impact of a reminder system on the reduction of diagnostic errors: a quasi-experimental study.
Article in BMC medical informatics and decision making, 2006. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 31 papers, 2 of them syntheses that pooled it.
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Who cites it
31 citing papers in PubMed, 2 syntheses or guidelines pooled it, 63 citations in OpenAlex.
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- The Effectiveness of Electronic Differential Diagnoses (DDX) Generators: A Systematic Review and Meta-Analysis.PloS one · 2016Pooled it
- Should electronic differential diagnosis support be used early or late in the diagnostic process? A multicentre experimental study of Isabel.BMJ quality & safety · 2022Trial
- Early diagnostic suggestions improve accuracy of GPs: a randomised controlled trial using computer-simulated patients.The British journal of general practice : the journal of the Royal College of General Practitioners · 2015Trial
- Collective Intelligence Increases Diagnostic Accuracy in a General Practice Setting.Medical decision making : an international journal of the Society for Medical Decision Making · 2024Article
- Emergency department use of an electronic differential diagnosis generator in the evaluation of critically ill patients.Internal and emergency medicine · 2024Observational
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- Physicians' Perspectives on a Multi-Dimensional Model for the Roles of Electronic Health Records in Approaching a Proper Differential Diagnosis.Journal of personalized medicine · 2023Article
- A Novel Use of an Electronic Differential Diagnosis Generator in the Emergency Department Setting.Cureus · 2023Article
- Incidence of Diagnostic Errors Among Unexpectedly Hospitalized Patients Using an Automated Medical History-Taking System With a Differential Diagnosis Generator: Retrospective Observational Study.JMIR medical informatics · 2022Article
- Assessing the Performance of a New Artificial Intelligence-Driven Diagnostic Support Tool Using Medical Board Exam Simulations: Clinical Vignette Study.JMIR medical informatics · 2021Article
- Clinical Decision Support Systems for Diagnosis in Primary Care: A Scoping Review.International journal of environmental research and public health · 2021Article
- A Perspective from a Case Conference on Comparing the Diagnostic Process: Human Diagnostic Thinking vs. Artificial Intelligence (AI) Decision Support Tools.International journal of environmental research and public health · 2020Article
- Development of an Experimental System "Computer-Aided Diagnosis in Neurotology (CADINO)" for Vertigo.Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India · 2019Article
- Can a decision support system accelerate rare disease diagnosis? Evaluating the potential impact of Ada DX in a retrospective study.Orphanet journal of rare diseases · 2019Article
- Patient Safety Incidents Involving Sick Children in Primary Care in England and Wales: A Mixed Methods Analysis.PLoS medicine · 2017Article
- Comparative outcome studies of clinical decision support software: limitations to the practice of evidence-based system acquisition.Journal of the American Medical Informatics Association : JAMIA · 2015Article
- Cognitive debiasing 2: impediments to and strategies for change.BMJ quality & safety · 2013Article
- Use of health information technology to reduce diagnostic errors.BMJ quality & safety · 2013Review
- Using value of information to guide evaluation of decision supports for differential diagnosis: is it time for a new look?BMC medical informatics and decision making · 2013Article
Corrections and comments
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Authors and funding
8 authors at 7 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundComputerized decision support systems (DSS) have mainly focused on improving clinicians' diagnostic accuracy in unusual and challenging cases. However, since diagnostic omission errors may predominantly result from incomplete workup in routine clinical practice, the provision of appropriate patient- and context-specific reminders may result in greater impact on patient safety. In this experimental study, a mix of easy and difficult simulated cases were used to assess the impact of a novel diagnostic reminder system (ISABEL) on the quality of clinical decisions made by various grades of clinicians during acute assessment.
methodsSubjects of different grades (consultants, registrars, senior house officers and medical students), assessed a balanced set of 24 simulated cases on a trial website. Subjects recorded their clinical decisions for the cases (differential diagnosis, test-ordering and treatment), before and after system consultation. A panel of two pediatric consultants independently provided gold standard responses for each case, against which subjects' quality of decisions was measured. The primary outcome measure was change in the count of diagnostic errors of omission (DEO). A more sensitive assessment of the system's impact was achieved using specific quality scores; additional consultation time resulting from DSS use was also calculated.
results76 subjects (18 consultants, 24 registrars, 19 senior house officers and 15 students) completed a total of 751 case episodes. The mean count of DEO fell from 5.5 to 5.0 across all subjects (repeated measures ANOVA, p < 0.001); no significant interaction was seen with subject grade. Mean diagnostic quality score increased after system consultation (0.044; 95% confidence interval 0.032, 0.054). ISABEL reminded subjects to consider at least one clinically important diagnosis in 1 in 8 case episodes, and prompted them to order an important test in 1 in 10 case episodes. Median extra time taken for DSS consultation was 1 min (IQR: 30 sec to 2 min).
conclusionThe provision of patient- and context-specific reminders has the potential to reduce diagnostic omissions across all subject grades for a range of cases. This study suggests a promising role for the use of future reminder-based DSS in the reduction of diagnostic error.
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