Reducing delays to diagnosis in ambulatory care settings: A macrocognition perspective

doi:10.1016/j.apergo.2019.102965

. 2020 Jan:82:102965.

doi: 10.1016/j.apergo.2019.102965. Epub 2019 Oct 9.

Reducing delays to diagnosis in ambulatory care settings: A macrocognition perspective

Emily S Patterson¹, George Su², Urmimala Sarkar³

Affiliations

¹ The Ohio State University, Division of Health Information Management and Systems, School of Health and Rehabilitation Sciences, College of Medicine, USA. Electronic address: patterson.150@osu.edu.
² University of California San Francisco, Division of General Internal Medicine, UCSF Center for Vulnerable Populations, USA.
³ University of California San Francisco, Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, USA.

PMID: 31605828
PMCID: PMC7757423
DOI: 10.1016/j.apergo.2019.102965

Reducing delays to diagnosis in ambulatory care settings: A macrocognition perspective

Emily S Patterson et al. Appl Ergon. 2020 Jan.

. 2020 Jan:82:102965.

doi: 10.1016/j.apergo.2019.102965. Epub 2019 Oct 9.

Authors

Emily S Patterson¹, George Su², Urmimala Sarkar³

Affiliations

¹ The Ohio State University, Division of Health Information Management and Systems, School of Health and Rehabilitation Sciences, College of Medicine, USA. Electronic address: patterson.150@osu.edu.
² University of California San Francisco, Division of General Internal Medicine, UCSF Center for Vulnerable Populations, USA.
³ University of California San Francisco, Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, USA.

PMID: 31605828
PMCID: PMC7757423
DOI: 10.1016/j.apergo.2019.102965

Abstract

We aim to use a macrocognition theoretical perspective to characterize contributors to diagnostic delays by physicians that can be mitigated by work system redesign. As experienced with other complex, sociotechnical domains, system redesign is anticipated to be more effective at improving safety than training-based solutions. In the outpatient care setting, complex tasks, conducted by a primary care provider, are provided for five macrocognition functions: sensemaking, re-planning, detecting problems, deciding, and coordinating. Redesigning systems could reduce delays to diagnosis by helping users to avoid missed symptoms, forgotten follow-up activities, and delayed actions. Health information technology could support resilience strategies by offloading documentation burdens, recording working diagnoses, displaying planned follow-up activities at the correct time interval, and supporting recognition of patterns in patient care. These insights suggest a path forward for future research on system design innovations to reduce diagnostic delays, and ultimately, reduce patient harm.

Keywords: Ambulatory care; Delayed diagnosis; Human factors; Medical informatics; Patient harm.

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Conflict of interest statement

Competing interests statement: The authors have no competing interests to declare.

Figures

**Figure 1:**
Relationship of complex tasks, macrocognition functions, vulnerabilities, and resilience strategies to delays in diagnosis.

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References

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[1] Aiken LH, Sloane DM, Bruyneel L, Van den Heede K, Griffiths P, Busse R, … & McHugh MD (2014). Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study. The Lancet, 383(9931), 1824–1830. - PMC - PubMed

[2] Aiken LH, Sloane DM, Bruyneel L, Van den Heede K, Griffiths P, Busse R, … & McHugh MD (2014). Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study. The Lancet, 383(9931), 1824–1830. - PMC - PubMed

[3] Bunting RF, & Groszkruger DP (2016). From to err is human to improving diagnosis in health care: the risk management perspective. Journal of Healthcare Risk Management, 35(3), 10–23. - PubMed

[4] Bunting RF, & Groszkruger DP (2016). From to err is human to improving diagnosis in health care: the risk management perspective. Journal of Healthcare Risk Management, 35(3), 10–23. - PubMed

[5] Carayon P, Hundt AS, Karsh BT, Gurses AP, Alvarado CJ, Smith M, & Brennan PF (2006). Work system design for patient safety: the SEIPS model. BMJ Quality & Safety, 15(suppl 1), i50–i58. - PMC - PubMed

[6] Carayon P, Hundt AS, Karsh BT, Gurses AP, Alvarado CJ, Smith M, & Brennan PF (2006). Work system design for patient safety: the SEIPS model. BMJ Quality & Safety, 15(suppl 1), i50–i58. - PMC - PubMed

[7] Card SK, Robertson GG, & Mackinlay JD (1991, April). The information visualizer, an information workspace In Proceedings of the SIGCHI Conference on Human factors in computing systems (pp. 181–186). ACM.

[8] Card SK, Robertson GG, & Mackinlay JD (1991, April). The information visualizer, an information workspace In Proceedings of the SIGCHI Conference on Human factors in computing systems (pp. 181–186). ACM.

[9] Croskerry P, Singhal G, & Mamede S (2013). Cognitive debiasing 2: impediments to and strategies for change. BMJ Qual Saf, bmjqs-2012. - PMC - PubMed

[10] Croskerry P, Singhal G, & Mamede S (2013). Cognitive debiasing 2: impediments to and strategies for change. BMJ Qual Saf, bmjqs-2012. - PMC - PubMed

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Reducing delays to diagnosis in ambulatory care settings: A macrocognition perspective

Affiliations

Reducing delays to diagnosis in ambulatory care settings: A macrocognition perspective

Authors

Affiliations

Abstract

Conflict of interest statement

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References

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Research Materials