TOP ED VULNERABILITY CLINICAL DECISION-MAKING Coverys malpractice data reveals that 67% of diagnostic-related events in the ED involved one or more elements of clinical decision-making. Clinical decision-making is the very foundation of the diagnostic process, requiring the gathering and synthesis of information from numerous sources to determine all the possible causes of the patient’s clinical presentation. While it is no surprise to find that 67% of diagnostic-related events in the ED involved clinical decision-making, uncovering the specific vulnerabilities within that process provides the insights needed to improve diagnoses. Coverys malpractice data reveals the following voids and failures in the decision-making process: • Incomplete information gathering, such as lack of patient/family history. • Insufficient consideration of differential diagnoses. • Incomplete or delayed testing or results. • Inaccurate test interpretation. • Delayed consults or specialty care. Clinical systems and communication are also key contributors to diagnostic failure – resulting in missing clinical data and test results, premature discharge, and delayed patient transfers. ( 6 ) Key definitions: • Anchoring bias: The tendency to perceptually lock on to salient features of the patient’s initial presentation too early in the diagnostic process. • Confirmation bias: Looking for confirming evidence to support a diagnosis rather than disconfirming evidence to refute it. Did you know? Cognitive bias is recognized as a potential contributor to incomplete differentials and clinical decision-making. One study7 found that 32% of 3,544 ED cases had elements of bias, e.g., anchoring or confirmation. 67% of events involve clinical decision-making. 19% of events involve clinical systems and communication. | HIDDEN IN PLAIN SIGHT | Exposing the Drivers of Diagnostic Error A DOSE OF INSIGHT ® Coverys |