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Cited by 49Clinical Reasoning and Diagnostic SkillsPatient Safety and Medication ErrorsElectronic Health Records Systems

Developing Checklists to Prevent Diagnostic Error in Emergency Room Settings

Open access
Graber, Mark L., Sorensen, Asta V., Biswas, Jon, Modi, Varsha, Wackett, Andrew, Johnson, Scott, Lenfestey, Nancy, Meyer, Ashley N.D. +1 more·2014·Diagnosis
DOI 10.1515/dx-2014-0019PMC PMC4799784
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Abstract

Background: Checklists have been shown to improve performance of complex, error-prone processes. To develop a checklist with potential to reduce the likelihood of diagnostic error for patients presenting to the Emergency Room (ER) with undiagnosed conditions. Methods: Participants included 15 staff ER physicians working in two large academic centers. A rapid cycle design and evaluation process was used to develop a general checklist for high-risk situations vulnerable to diagnostic error. Physicians used the general checklists and a set of symptom-specific checklists for a period of 2 months. We conducted a mixed methods evaluation that included interviews regarding user perceptions and quantitative assessment of resource utilization before and after checklist use. Results: A general checklist was developed iteratively by obtaining feedback from users and subject matter experts, and was trialed along with a set of specific checklists in the ER. Both the general and the symptom-specific checklists were judged to be helpful, with a slight preference for using symptom-specific lists. Checklist use commonly prompted consideration of additional diagnostic possibilities, changed the working diagnosis in approximately 10% of cases, and anecdotally was thought to be helpful in avoiding diagnostic errors. Checklist use was prompted by a variety of different factors, not just diagnostic uncertainty. None of the physicians used the checklists in collaboration with the patient, despite being encouraged to do so. Checklist use did not prompt large changes in test ordering or consultation. Conclusions: In the ER setting, checklists for diagnosis are helpful in considering additional diagnostic possibilities, thus having potential to prevent diagnostic errors. Inconsistent usage and using the checklists privately, instead of with the patient, are factors that may detract from obtaining maximum benefit. Further research is needed to optimize checklists for use in the ER, determine how to increase usage, to evaluate the impact of checklist utilization on error rates and patient outcomes, to determine how checklist usage affects test ordering and consultation, and to compare checklists generally with other approaches to reduce diagnostic error.

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  • Checklists assist clinicians in considering a broader range of potential factors and encourage a more comprehensive review of important items and variables.

    “They also assist clinicians in considering a broader range of potential factors and encourage a more comprehensive review of important items and variables [204,205].”

    From Toward Safer Diagnoses: A SEIPS-Based Narrative Review of Diagnostic Errors (2026) · cites this paper as [205]

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Research works printed but not linked: 5

  1. [2]Graber M The incidence of diagnostic error BMJ Qual Saf 2013 22 Part 2 ii21 ii7 PMC3786666 23771902
  2. [21]Ely JW Osheroff JA Checklists to prevent diagnostic errors Abstract, Presented at: Diagnostic Error in Medicine Annual Conference Phoenix-AZ 2008
  3. [28]Miles M Huberman A Qualitative analysis: an expanded sourcebook 2nd Thousand Oaks, CA Sage Publications 1994
  4. [34]Meyer AN Payne VL Meeks DW Rao R Singh H Physicians’ diagnostic accuracy, confidence, and resource requests JAMA Internal Med 2013 173 1952 8 23979070
  5. [37]Chopra V Shojania K Recipe for checklists and bundles – one part active ingredient and one part measurement Qual Saf Health Care 2013 22 93 6 23035255

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Authors
Graber, M. L., Sorensen, A. V., Biswas, J., Modi, V., Wackett, A., Johnson, S., Lenfestey, N., Meyer, A. N. D., & Singh, H.
Affiliations
  • State University of New York (US)
  • RTI International (US)
  • Michael E. DeBakey VA Medical Center (US)
  • Stony Brook University Hospital (US)
Corresponding author
Graber, Mark L.
ORCID
Venue
Diagnosis
Publisher
Walter de Gruyter GmbH
Published
2014-06-19
Volume
1
Issue
3
Pages
223-231
ISSN
  • 2194-8011 (ISSN-L)
  • 2194-802X
DOI
10.1515/dx-2014-0019
PMC
PMC4799784
OpenAlex
W2031871309
Cited by
49
References
41
Citations by year
2026: 4 · 2025: 5 · 2024: 2 · 2023: 3 · 2022: 3 · 2021: 6 · 2020: 7 · 2019: 9 · 2018: 2 · 2017: 3 · 2016: 2 · 2015: 2 · 2014: 1
FWCI
2.75
Type
journal article
Language
en
Open access
Licence
Locations
  • Diagnosis (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Cancer Institute (K23CA125585)
Topics
  • Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
  • Health Sciences › Health Professions › Emergency Medical Services › Patient Safety and Medication Errors
  • Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
Keywords
diagnostic errors, checklists, emergency department, diagnostic error prevention, physician decision-making, diagnostic uncertainty, patient engagement, test ordering

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