Exploring situational awareness in diagnostic errors in primary care

Hardeep Singh, Traber Davis Giardina, Laura A. Petersen, Michael W. Smith, Lindsey Wilson Paul, Key Dismukes, Gayathri Bhagwath, Eric J. Thomas

Research output: Contribution to journalArticle

45 Citations (Scopus)

Abstract

Objective: Diagnostic errors in primary care are harmful but poorly studied. To facilitate the understanding of diagnostic errors in real-world primary care settings that use electronic health records (EHRs), this study explored the use of the situational awareness (SA) framework from aviation human factors research. Methods: A mixed-methods study was conducted involving reviews of EHR data followed by semi-structured interviews of selected providers from two institutions in the USA. The study population included 380 consecutive patients with colorectal and lung cancers diagnosed between February 2008 and January 2009. Using a pre-tested data collection instrument, trained physicians identified diagnostic errors, defined as lack of timely action on one or more established indications for diagnostic work-up for lung and colorectal cancers. Twenty-six providers involved in cases with and without errors were interviewed. Interviews probed for providers' lack of SA and how this may have influenced the diagnostic process. Results: Of 254 cases meeting inclusion criteria, errors were found in 30 of 92 (32.6%) lung cancer cases and 56 of 167 (33.5%) colorectal cancer cases. Analysis of interviews related to error cases revealed evidence of lack of one of four levels of SA applicable to primary care practice: information perception, information comprehension, forecasting future events, and choosing appropriate action based on the first three levels. In cases without error, application of the SA framework provided insight into processes involved in attention management. Conclusions: A framework of SA can help analyse and understand diagnostic errors in primary care settings that use EHRs.

Original languageEnglish (US)
Pages (from-to)30-38
Number of pages9
JournalBMJ Quality and Safety
Volume21
Issue number1
DOIs
StatePublished - Jan 1 2012

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Diagnostic Errors
Primary Health Care
Electronic Health Records
Colorectal Neoplasms
Lung Neoplasms
Interviews
Aviation
Physicians
Research
Population

ASJC Scopus subject areas

  • Health Policy

Cite this

Singh, H., Giardina, T. D., Petersen, L. A., Smith, M. W., Paul, L. W., Dismukes, K., ... Thomas, E. J. (2012). Exploring situational awareness in diagnostic errors in primary care. BMJ Quality and Safety, 21(1), 30-38. https://doi.org/10.1136/bmjqs-2011-000310

Exploring situational awareness in diagnostic errors in primary care. / Singh, Hardeep; Giardina, Traber Davis; Petersen, Laura A.; Smith, Michael W.; Paul, Lindsey Wilson; Dismukes, Key; Bhagwath, Gayathri; Thomas, Eric J.

In: BMJ Quality and Safety, Vol. 21, No. 1, 01.01.2012, p. 30-38.

Research output: Contribution to journalArticle

Singh, H, Giardina, TD, Petersen, LA, Smith, MW, Paul, LW, Dismukes, K, Bhagwath, G & Thomas, EJ 2012, 'Exploring situational awareness in diagnostic errors in primary care', BMJ Quality and Safety, vol. 21, no. 1, pp. 30-38. https://doi.org/10.1136/bmjqs-2011-000310
Singh H, Giardina TD, Petersen LA, Smith MW, Paul LW, Dismukes K et al. Exploring situational awareness in diagnostic errors in primary care. BMJ Quality and Safety. 2012 Jan 1;21(1):30-38. https://doi.org/10.1136/bmjqs-2011-000310
Singh, Hardeep ; Giardina, Traber Davis ; Petersen, Laura A. ; Smith, Michael W. ; Paul, Lindsey Wilson ; Dismukes, Key ; Bhagwath, Gayathri ; Thomas, Eric J. / Exploring situational awareness in diagnostic errors in primary care. In: BMJ Quality and Safety. 2012 ; Vol. 21, No. 1. pp. 30-38.
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