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Simulation and the diagnostic process: a pilot study of trauma and rapid response teams

  • Lindsay L. Juriga , David J. Murray EMAIL logo , John R. Boulet and James J. Fehr
Published/Copyright: July 28, 2017
Diagnosis
From the journal Diagnosis Volume 4 Issue 4

Abstract

Background:

Simulation is frequently used to recreate many of the crises encountered in patient care settings. Teams learn to manage these crises in an environment that maximizes their learning experiences and eliminates the potential for patient harm. By designing simulation scenarios that include conditions associated with diagnostic errors, teams can experience how their decisions can lead to errors. The purpose of this study was to assess how trauma teams (TrT) and pediatric rapid response teams (RRT) managed scenarios that included a diagnostic error.

Methods:

We developed four scenarios that would require TrT and pediatric RRT to manage an error in diagnosis. The two trauma scenarios (spinal cord injury and tracheobronchial tear) were designed to not respond to the heuristic management approach frequently used in trauma settings. The two pediatric scenarios (foreign body aspiration and coarctation of the aorta) had an incorrect diagnosis on admission. Two raters independently scored the scenarios using a rating system based on how teams managed the diagnostic process (search, establish and confirm a new diagnosis and initiate therapy based on the new diagnosis).

Results:

Twenty-one TrT and 17 pediatric rapid response managed 51 scenarios. All of the teams questioned the initial diagnosis. The teams were able to establish and confirm a new diagnosis in 49% of the scenarios (25 of 51). Only 23 (45%) teams changed their management of the patient based on the new diagnosis.

Conclusions:

Simulation can be used to recreate conditions that engage teams in the diagnostic process. In contrast to most instruction about diagnostic error, teams learn through realistic experiences and receive timely feedback about their decision-making skills. Based on the findings in this pilot study, the majority of teams would benefit from an education intervention designed to improve their diagnostic skills.

Keywords: diagnostic process; education; patient safety; rapid response teams; simulation; trauma teams
Corresponding author: David J. Murray, Director, Wood Simulation Center, Carol B. and Jerome T. Loeb Professor, Division of Pediatric Anesthesiology, Department of Anesthesiology, Washington University School of Medicine, Box 8054, St. Louis, MO, USA, Phone: +314-457-3116, Fax: +314-454-2296

  1. Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

  2. Research funding: AHRQ: R18 HS022265-01 Murray, David John. Critical Care Management: A Simulation-Based Assessment of Decision-Making Skills. (Principle Investigator) 7/1/13-4/30/17.

  3. AHRQ: RO1 HS018734-01, Murray [PI]. Teamwork, Communication and Decision-making: An Assessment Program Using Simulation. NIH Agency for Healthcare Research and Quality [AHRQ].

  4. Employment or leadership: None declared.

  5. Honorarium: None declared.

  6. Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

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Received: 2017-2-28
Accepted: 2017-6-24
Published Online: 2017-7-28
Published in Print: 2017-11-27

©2017 Walter de Gruyter GmbH, Berlin/Boston

Articles in the same Issue

  1. Frontmatter
  2. Editorials
  3. Laboratory-related errors: you cannot manage what you don’t measure. You manage what you know and measure
  4. Nurses, diagnosis and diagnostic error
  5. Reviews
  6. Defining the critical role of nurses in diagnostic error prevention: a conceptual framework and a call to action
  7. The impact of electronic health records on diagnosis
  8. Opinion Papers
  9. The new diagnostic team
  10. The key role of differential diagnosis in diagnosis
  11. Original Articles
  12. Simulation and the diagnostic process: a pilot study of trauma and rapid response teams
  13. Exploring the sources and mechanisms of cognitive errors in medical diagnosis with associative memory models
  14. Case Report
  15. Not all that vesicles is herpes
  16. Acknowledgment
  17. Congress Abstracts
  18. Diagnostic Error in Medicine
https://doi.org/10.1515/dx-2017-0010
Keywords for this article
diagnostic process; education; patient safety; rapid response teams; simulation; trauma teams

Articles in the same Issue

  1. Frontmatter
  2. Editorials
  3. Laboratory-related errors: you cannot manage what you don’t measure. You manage what you know and measure
  4. Nurses, diagnosis and diagnostic error
  5. Reviews
  6. Defining the critical role of nurses in diagnostic error prevention: a conceptual framework and a call to action
  7. The impact of electronic health records on diagnosis
  8. Opinion Papers
  9. The new diagnostic team
  10. The key role of differential diagnosis in diagnosis
  11. Original Articles
  12. Simulation and the diagnostic process: a pilot study of trauma and rapid response teams
  13. Exploring the sources and mechanisms of cognitive errors in medical diagnosis with associative memory models
  14. Case Report
  15. Not all that vesicles is herpes
  16. Acknowledgment
  17. Congress Abstracts
  18. Diagnostic Error in Medicine
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