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Cited by 37Clinical Reasoning and Diagnostic SkillsPatient Safety and Medication ErrorsElectronic Health Records Systems

Checklists to Prevent Diagnostic Errors: A Pilot Randomized Controlled Trial

Open access
Ely, John W., Graber, Mark A.·2015·Diagnosis
DOI 10.1515/dx-2015-0008
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Abstract

Background: Many diagnostic errors are caused by premature closure of the diagnostic process. To help prevent premature closure, we developed checklists that prompt physicians to consider all reasonable diagnoses for symptoms that commonly present in primary care. Methods: We enrolled 14 primary care physicians and 100 patients in a randomized clinical trial. The study took place in an emergency department (5 physicians) and a same-day access clinic (9 physicians). The physicians were randomized to usual care vs. diagnostic checklist. After completing the history and physical exam, checklist physicians read aloud a differential diagnosis checklist for the chief complaint. The primary outcome was diagnostic error, which was defined as a discrepancy between the diagnosis documented at the acute visit and the diagnosis based on a 1-month follow-up phone call and record review. Results: There were 17 diagnostic errors. The mean error rate among the seven checklist physicians was not significantly different from the rate among the seven usual-care physicians (11.2% vs. 17.8%; p=0.46). In a post-hoc subgroup analysis, emergency physicians in the checklist group had a lower mean error rate than emergency physicians in the usual-care group (19.1% vs. 45.0%; p=0.04). Checklist physicians considered more diagnoses than usual-care physicians during the patient encounters (6.5 diagnoses [SD 4.2] vs. 3.4 diagnoses [SD 2.0], p<0.001). Conclusions: Checklists did not improve the diagnostic error rate in this study. However further development and testing of checklists in larger studies may be warranted.

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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 [204]

    The Main findings report that physicians using a checklist generated a broader differential diagnosis, and the Intervention describes a review of possible diagnoses, including commonly missed and serious ones. This supports broader consideration and review of diagnostic possibilities, but the paper does not establish the broader claim about reviewing important items and variables generally. (LLM, conf=0.83)

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Research works printed but not linked: 2

  1. Schiff GD, Leape LL. Commentary: how can we make diagnosis safer? Acad Med 2012;87:135-8.
  2. Meyer AN, Payne VL, Meeks DW, Rao R, Singh H. Physicians' diagnostic accuracy, confidence, and resource requests. J Am Med Assoc Intern Med 2013;173:1952-8.

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Authors
Ely, J. W., & Graber, M. A.
Affiliations
University of Iowa (US)
Corresponding author
Ely, John W.
ORCID
Venue
Diagnosis
Publisher
Walter de Gruyter GmbH
Published
2015-05-13
Volume
2
Issue
3
Pages
163-169
ISSN
  • 2194-8011 (ISSN-L)
  • 2194-802X
DOI
10.1515/dx-2015-0008
OpenAlex
W2214474504
Cited by
37
References
36
Citations by year
2026: 2 · 2025: 1 · 2023: 4 · 2022: 7 · 2021: 8 · 2020: 3 · 2019: 7 · 2018: 2 · 2017: 2
FWCI
1.56
Type
journal article
Language
en
Open access
Licence
Locations
  • Diagnosis (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
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, premature closure, differential diagnosis, primary care, emergency department, diagnostic error prevention, physician decision-making, telephone follow-up

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