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Do you have to re-examine to reconsider your diagnosis? Checklists and cardiac exam.

Abstract：

BACKGROUND:Few studies have investigated whether clinicians can use checklists to verify their diagnostic decisions. Checklists may improve accuracy by prompting clinicians to reconsider or recollect information but might impair decision making by adding to clinicians' cognitive load. This study assessed whether checklists improve cardiac exam diagnostic accuracy, and whether this benefit is dependent on collecting additional information. METHODS:191 internal medicine residents examined a cardiopulmonary simulator. They provided a diagnosis, subjective rating of certainty, and key findings before and after using a checklist. Residents were randomised; half were allowed access to the simulator and half were prohibited access to the simulator while using the checklist. Residents rated their cognitive load in each step: prechecklist diagnosis, checklist use and postchecklist diagnosis. RESULT:Verifying with a checklist resulted in improved diagnostic accuracy; 88 residents (46%) made the correct diagnosis before using the checklist compared with 97 (51%) afterwards, p=0.04. The benefit of checklist use was restricted to residents allowed to re-examine the simulator (10 changed to correct diagnosis and one to an incorrect diagnosis) whereas no net benefit was seen among residents unable to re-examine the simulator (two changed to a correct diagnosis and two to an incorrect diagnosis, p=0.03). Those able to re-examine the simulator were slightly more confident after checklist use, whereas those unable to re-examine were slightly less confident after checklist use (p=0.01). The opportunity to re-examine the simulator had no effect on the accuracy of key findings reported. Of the three steps, checklist use was associated with the lowest cognitive load (F1,189=68 p<0.001). CONCLUSIONS:Verifying diagnostic decisions with a checklist improved diagnostic accuracy. This benefit was only seen when more information could be collected. Checklist use was not associated with increased cognitive load.

journal_name

BMJ Qual Saf

journal_title

BMJ quality & safety

authors

Sibbald M,de Bruin AB,Cavalcanti RB,van Merrienboer JJ

doi

10.1136/bmjqs-2012-001537

subject

Has Abstract

pub_date

2013-04-01 00:00:00

pages

333-8

issue

eissn

2044-5415

issn

2044-5423

pii

bmjqs-2012-001537

journal_volume

pub_type

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Do you have to re-examine to reconsider your diagnosis? Checklists and cardiac exam.