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BMC Health Services Research
Published in: BMC Health Services Research 1/2009

Open Access 01-12-2009 | Study protocol

Design of a study on suboptimal cognitive acts in the diagnostic process, the effect on patient outcomes and the influence of workload, fatigue and experience of physician

Authors: Laura Zwaan, Abel Thijs, Cordula Wagner, Gerrit van der Wal, Daniëlle RM Timmermans

Published in: BMC Health Services Research | Issue 1/2009

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Abstract

Background

Diagnostic error is an important error type since diagnostic adverse events are regularly judged as being preventable and the consequences are considered to be severe. Existing research often focuses on either diagnostic adverse events or on the errors in diagnostic reasoning. Whether and when an incorrect diagnostic process results in adverse outcomes has not been studied extensively. The present paper describes the design of a study that aims to study the relationship between a suboptimal diagnostic process and patient outcomes. In addition, the role of personal and circumstantial factors on the quality of the diagnostic process will be examined.

Methods/Design

The research questions were addressed using several data sources. First, the differential diagnosis was assessed concurrently to the diagnostic process. Second, the patient records of 248 patients suffering from shortness of breath were reviewed by expert internists in order to reveal suboptimal cognitive acts and (potential) consequences for the patient. The suboptimal cognitive acts were discussed with the treating physicians and classified with the taxonomy of unsafe acts. Third, workload, fatigue and work experience were measured during the physicians work. Workload and fatigue were measured during the physicians shift using the NASA tlx questionnaire on a handheld computer. Physicians participating in the study also answered questions about their work experience.

Discussion

The design used in this study provides insight into the relationship between suboptimal cognitive acts in the diagnostic process and possible consequences for the patient. Suboptimal cognitive acts in the diagnostic process and its causes can be revealed. Additional measurements of workload, fatigue and experience allow examining the influence of these factors on the diagnostic process. In conclusion, the present design provides a method with which insights in weaknesses of the diagnostic process and the effect on patient outcomes can be studied and opportunities for improvement can be obtained.
Appendix
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Metadata
Title
Design of a study on suboptimal cognitive acts in the diagnostic process, the effect on patient outcomes and the influence of workload, fatigue and experience of physician
Authors
Laura Zwaan
Abel Thijs
Cordula Wagner
Gerrit van der Wal
Daniëlle RM Timmermans
Publication date
01-12-2009
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2009
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/1472-6963-9-65

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