Clinical decision support tool improves doctors' diagnostic skills in just one minute

Isabel, a web-based clinical decision support system, prevents diagnostic errors and improves the quality of treatment decisions made by clinicians. A study published today in the open access journal BMC Medical Informatics and Decision Making reveals that consulting Isabel prompted pediatricians to make an important change to their diagnosis in 12.5% of cases analysed. Consulting Isabel added only one minute to the time taken to diagnose, and improved diagnostic accuracy for both easy and difficult cases.

The study was conducted by Padmanabhan Ramnarayan, from Great Ormond Street Hospital for Children, London, UK, and colleagues from other hospitals in the UK and Isabel Healthcare, UK. Seventy-six pediatricians of different grades, including senior physicians and final year medical students, were asked to diagnose 24 different simulated cases on a trial website. The cases included easy, routine clinical problems as well as complicated cases. They were based on real histories of children who had reported to hospital in the preceding months. In total, 751 cases diagnosed by 76 participants were analysed. The participants recorded their diagnostic decisions before and after consulting Isabel. The number of errors, especially errors of omission, where the participants forgot to consider important diagnoses, was recorded.

Consulting Isabel resulted in an important change in diagnostic decision-making in 12.5% of all cases, and over half of participants were reminded of at least one clinically important diagnosis by Isabel. The mean number of omissions for each participant was 5.5 before consultation of Isabel, it dropped to 5.0 after consultation. The most likely diagnosis was present in 67.5% of analyses before consultation and in 74.7% of analyses after consultation.

Misdiagnosis is the largest cause of preventable medical error and accounts for over 40% of medical malpractice claims. It has also been shown to be a key concern of patients, a recent survey by YouGov revealing that misdiagnosis had affected 1 in 5 of the adult population in the UK and 1 in 6 in the USA.

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Article:

Assessment of the potential impact of a reminder system on the reduction of diagnostic errors: a quasi-experimental study Padmanabhan Ramnarayan, Graham C Roberts, Michael Coren, Vasantha Nanduri, Amanda Tomlinson, Paul M Taylor, Jeremy C Wyatt and Joseph F Britto

BMC Medical Informatics and Decision Making 2006, (in press) http://www.biomedcentral.com/bmcmedinformdecismak/


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