Article review: Diagnostic errors in the ICU. “Better cognitive tools needed”
DDX tools could help to avoid diagnosis errors in the ICU
The idea for the Isabel diagnosis support tool first came to us while sitting in the ICU. A decade ago, my family and I were spending long hours in the ICU caring for our toddler, Isabel Maude, after she was diagnosed late with necrotising fasciitis. We realized the ICU doctors often can see the long perspective of what happened to a patient, as they see how the patient got there and what mistakes were made along the way. With the luxury of hindsight they can see, for example, that if only a clinician had, metaphorically, turned left instead of right then the patient would not have ended up in ICU.
So, with great interest I read a review of diagnostic errors actually made in the ICU in an article published by by Bradford Winters et al at Johns Hopkins.
Do we need more papers telling us how much diagnostic error exists? Hopefully the message is starting to get through. A salient point in this paper is that out of the 31 studies covering 5,863 autopsies, 28% reported at least one misdiagnosis. The authors estimate that as many as 40,500 adult patients annually may die in the ICU with a misdiagnosis. This number of predicted deaths is comparable to those from central line associated bloodstream infections or breast cancer.
The most interesting part, though, was what Winters said in the communications accompanying the paper:
“It may be counterintuitive to think that the patients who are the most closely monitored and frequently tested are more commonly misdiagnosed, but the ICU is a very complex environment,” Winters says. Clinicians face a deluge of information in a distracting environment in which the sickest patients compete for attention, most without being able to communicate with their medical team. “We need to develop better cognitive tools that can take into account the 7,000 or more pieces of information that critical care physicians are bombarded with each day to ensure we’re not ruling out potential diagnoses,” Winters says.
This point is yet another good argument for using differential diagnosis tools, like Isabel, that are designed to help clinicians make sense of information, rather than just giving them more of it.
~ Jason Maude, Founder of Isabel Healthcare. View the Video of Jason and his daughter Isabel telling their story.