RT Journal Article
SR Electronic
T1 Validation of a diagnostic reminder system in emergency medicine: a multi-centre study
JF Emergency Medicine Journal
JO Emerg Med J
FD BMJ Publishing Group Ltd and the British Association for Accident & Emergency Medicine
SP 619
OP 624
DO 10.1136/emj.2006.044107
VO 24
IS 9
A1 Padmanabhan Ramnarayan
A1 Natalie Cronje
A1 Ruth Brown
A1 Rupert Negus
A1 Bill Coode
A1 Philip Moss
A1 Taj Hassan
A1 Wayne Hamer
A1 Joseph Britto
YR 2007
UL http://emj.bmj.com/content/24/9/619.abstract
AB Background: Diagnostic error is a significant problem in emergency medicine, where initial clinical assessment and decision making is often based on incomplete clinical information. Traditional computerised diagnostic systems have been of limited use in the acute setting, mainly due to the need for lengthy system consultation. We evaluated a novel web-based reminder system, which provides rapid diagnostic advice to users based on free text search terms. Methods: Clinical data collected from patients presenting to three emergency departments with acute medical problems were entered into the diagnostic system. The displayed results were assessed against the final discharge diagnoses for patients who were admitted to hospital (diagnostic accuracy) and against a set of “appropriate” diagnoses for each case provided by an expert panel (potential utility). Results: Data were collected from 594 patients (53.4% of screened attendances). Mean age was 49.4 years (95% CI 47.7 to 51.1) and the majority had significant past illnesses. Most were assessed first by junior doctors (70%) and 266/594 (44.6%) were admitted to hospital. Overall, the diagnostic system displayed the final discharge diagnosis in 95% of inpatients and 90% of “must-not-miss” diagnoses suggested by the expert panel. The discharge diagnosis appeared within the first 10 suggestions in 78% of cases. Conclusions: The Isabel diagnostic aid has been shown to be of potential use in reminding junior doctors of key diagnoses in the emergency department. The effects of its widespread use on decision making and diagnostic error can be clarified by evaluating its impact on routine clinical decision making.