Cited by 366Clinical Reasoning and Diagnostic SkillsPatient Safety and Medication ErrorsDecision-Making and Behavioral Economics

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Checklists to Reduce Diagnostic Errors

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Ely, John W., Graber, Mark L., Croskerry, Pat·2011·Academic Medicine

DOI 10.1097/acm.0b013e31820824cd

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Abstract

Diagnostic errors are common and can often be traced to physicians' cognitive biases and failed heuristics (mental shortcuts). A great deal is known about how these faulty thinking processes lead to error, but little is known about how to prevent them. Faulty thinking plagues other high-risk, high-reliability professions, such as airline pilots and nuclear plant operators, but these professions have reduced errors by using checklists. Recently, checklists have gained acceptance in medical settings, such as operating rooms and intensive care units. This article extends the checklist concept to diagnosis and describes three types of checklists: (1) a general checklist that prompts physicians to optimize their cognitive approach, (2) a differential diagnosis checklist to help physicians avoid the most common cause of diagnostic error--failure to consider the correct diagnosis as a possibility, and (3) a checklist of common pitfalls and cognitive forcing functions to improve evaluation of selected diseases. These checklists were developed informally and have not been subjected to rigorous evaluation. The purpose of this article is to argue for the further investigation and revision of these initial attempts to apply checklists to the diagnostic process. The basic idea behind checklists is to provide an alternative to reliance on intuition and memory in clinical problem solving. This kind of solution is demanded by the complexity of diagnostic reasoning, which often involves sense-making under conditions of great uncertainty and limited time.

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Authors: Ely, J. W., Graber, M. L., & Croskerry, P.
Affiliations: University of Iowa (US)
Corresponding author: Ely, John W.
ORCID: Ely, John W.
Graber, Mark L.
Croskerry, Pat
Venue: Academic Medicine
Publisher: Oxford University Press (OUP)
Published: 2011-03
Volume: 86
Issue: 3
Pages: 307-313
ISSN: 1040-2446 (ISSN-L)
DOI: 10.1097/acm.0b013e31820824cd
OpenAlex: W2321464116
Cited by: 366
References: 65
Citations by year: 2026: 15 · 2025: 18 · 2024: 24 · 2023: 20 · 2022: 34 · 2021: 29 · 2020: 28 · 2019: 35 · 2018: 18 · 2017: 20 · 2016: 26 · 2015: 26 · 2014: 22 · 2013: 23 · 2012: 18
FWCI: 21.49
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: Academic Medicine (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Patient Safety and Medication Errors
Social Sciences › Decision Sciences › General Decision Sciences › Decision-Making and Behavioral Economics
Keywords: diagnostic errors, checklists, cognitive biases, heuristics, differential diagnosis, diagnostic reasoning, clinical decision-making, error prevention, medical education
MeSH terms: Cognition, Decision Making, Diagnosis, Differential, Diagnostic Errors, Humans, Memory, Problem Solving, Checklist

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