Department of Diagnostic and Generalist Medicine, Dokkyo Medical University, Mibu, Tochigi, Japan
Department of Diagnostic and Generalist Medicine, Dokkyo Medical University, Mibu, Tochigi, Japan.
BMJ Qual Saf. 2024 May 17;33(6):386-394. doi: 10.1136/bmjqs-2022-015436.
There has been growing recognition that contextual factors influence the physician's cognitive processes. However, given that cognitive processes may depend on the physicians' specialties, the effects of contextual factors on diagnostic errors reported in previous studies could be confounded by difference in physicians.
This study aimed to clarify whether contextual factors such as location and consultation type affect diagnostic accuracy.
We reviewed the medical records of 1992 consecutive outpatients consulted by physicians from the Department of Diagnostic and Generalist Medicine in a university hospital between 1 January and 31 December 2019. Diagnostic processes were assessed using the Revised Safer Dx Instrument. Patients were categorised into three groups according to contextual factors (location and consultation type): (1) referred patients with scheduled visit to the outpatient department; (2) patients with urgent visit to the outpatient department; and (3) patients with emergency visit to the emergency room. The effect of the contextual factors on the prevalence of diagnostic errors was investigated using logistic regression analysis.
Diagnostic errors were observed in 12 of 534 referred patients with scheduled visit to the outpatient department (2.2%), 3 of 599 patients with urgent visit to the outpatient department (0.5%) and 13 of 859 patients with emergency visit to the emergency room (1.5%). Multivariable logistic regression analysis showed a significantly higher prevalence of diagnostic errors in referred patients with scheduled visit to the outpatient department than in patients with urgent visit to the outpatient department (OR 4.08, p=0.03), but no difference between patients with emergency and urgent visit to the emergency room and outpatient department, respectively.
Contextual factors such as consultation type may affect diagnostic errors; however, since the differences in the prevalence of diagnostic errors were small, the effect of contextual factors on diagnostic accuracy may be small in physicians working in different care settings.
越来越多的人认识到，上下文因素会影响医生的认知过程。然而，由于认知过程可能取决于医生的专业，因此之前研究中报告的诊断错误的上下文因素的影响可能因医生的差异而产生混淆。
本研究旨在阐明地理位置和咨询类型等上下文因素是否会影响诊断准确性。
我们回顾了 2019 年 1 月 1 日至 12 月 31 日期间，一名来自大学医院诊断和全科医学系的医生为 1992 名连续门诊患者就诊的病历。使用修订后的 Safer Dx 工具评估诊断过程。根据上下文因素（地理位置和咨询类型）将患者分为三组：（1）预约门诊就诊的转诊患者；（2）门诊紧急就诊的患者；（3）急诊就诊的患者。使用逻辑回归分析调查上下文因素对诊断错误发生率的影响。
在预约门诊就诊的 534 名转诊患者中观察到 12 例（2.2%）诊断错误，在 599 名门诊紧急就诊患者中观察到 3 例（0.5%），在 859 名急诊就诊患者中观察到 13 例（1.5%）。多变量逻辑回归分析显示，预约门诊就诊的转诊患者诊断错误的发生率明显高于门诊紧急就诊患者（OR 4.08，p=0.03），但急诊就诊患者与门诊紧急就诊患者之间无差异。
咨询类型等上下文因素可能会影响诊断错误；然而，由于诊断错误的发生率差异较小，因此在不同医疗环境中工作的医生，上下文因素对诊断准确性的影响可能较小。
