Factors influencing diagnostic accuracy among intensive care unit clinicians - an observational study.

IF 2.2 Q2 MEDICINE, GENERAL & INTERNAL
Diagnosis Pub Date : 2023-11-30 eCollection Date: 2024-02-01 DOI:10.1515/dx-2023-0026
Paul A Bergl, Neehal Shukla, Jatan Shah, Marium Khan, Jayshil J Patel, Rahul S Nanchal
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引用次数: 0

Abstract

Objectives: Diagnostic errors are a source of morbidity and mortality in intensive care unit (ICU) patients. However, contextual factors influencing clinicians' diagnostic performance have not been studied in authentic ICU settings. We sought to determine the accuracy of ICU clinicians' diagnostic impressions and to characterize how various contextual factors, including self-reported stress levels and perceptions about the patient's prognosis and complexity, impact diagnostic accuracy. We also explored diagnostic calibration, i.e. the balance of accuracy and confidence, among ICU clinicians.

Methods: We conducted an observational cohort study in an academic medical ICU. Between June and August 2019, we interviewed ICU clinicians during routine care about their patients' diagnoses, their confidence, and other contextual factors. Subsequently, using adjudicated final diagnoses as the reference standard, two investigators independently rated clinicians' diagnostic accuracy and on each patient on a given day ("patient-day") using 5-point Likert scales. We conducted analyses using both restrictive and conservative definitions of clinicians' accuracy based on the two reviewers' ratings of accuracy.

Results: We reviewed clinicians' responses for 464 unique patient-days, which included 255 total patients. Attending physicians had the greatest diagnostic accuracy (77-90 %, rated as three or higher on 5-point Likert scale) followed by the team's primary fellow (73-88 %). Attending physician and fellows were also least affected by contextual factors. Diagnostic calibration was greatest among ICU fellows.

Conclusions: Additional studies are needed to better understand how contextual factors influence different clinicians' diagnostic reasoning in the ICU.

影响重症监护病房临床医生诊断准确性的因素-一项观察性研究。
目的:诊断错误是重症监护病房(ICU)患者发病率和死亡率的一个来源。然而,影响临床医生诊断表现的环境因素尚未在真实的ICU环境中进行研究。我们试图确定ICU临床医生诊断印象的准确性,并描述各种背景因素(包括自我报告的压力水平和对患者预后和复杂性的看法)如何影响诊断准确性。我们还探讨了ICU临床医生的诊断校准,即准确性和置信度的平衡。方法:我们在一家学术医学ICU进行了一项观察性队列研究。在2019年6月至8月期间,我们在常规护理期间采访了ICU临床医生,了解他们的患者诊断、他们的信心和其他背景因素。随后,两名研究人员使用5分李克特量表,以最终诊断作为参考标准,独立评估临床医生的诊断准确性,并在给定的一天(“患者日”)对每个患者进行诊断。我们根据两位审稿人对准确性的评分,对临床医生的准确性使用限制性和保守性定义进行了分析。结果:我们回顾了临床医生对464个独特患者日的反应,其中包括255名患者。主治医生的诊断准确率最高(77-90 %,在5分李克特量表上被评为3分或更高),其次是团队的主要同事(73-88 %)。主治医师和研究员受环境因素的影响最小。诊断校准在ICU研究员中最高。结论:需要进一步的研究来更好地了解环境因素如何影响不同临床医生在ICU的诊断推理。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Diagnosis
Diagnosis MEDICINE, GENERAL & INTERNAL-
CiteScore
7.20
自引率
5.70%
发文量
41
期刊介绍: Diagnosis focuses on how diagnosis can be advanced, how it is taught, and how and why it can fail, leading to diagnostic errors. The journal welcomes both fundamental and applied works, improvement initiatives, opinions, and debates to encourage new thinking on improving this critical aspect of healthcare quality.  Topics: -Factors that promote diagnostic quality and safety -Clinical reasoning -Diagnostic errors in medicine -The factors that contribute to diagnostic error: human factors, cognitive issues, and system-related breakdowns -Improving the value of diagnosis – eliminating waste and unnecessary testing -How culture and removing blame promote awareness of diagnostic errors -Training and education related to clinical reasoning and diagnostic skills -Advances in laboratory testing and imaging that improve diagnostic capability -Local, national and international initiatives to reduce diagnostic error
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