Impact of disclosing a working diagnosis during simulated patient handoff presentation in the emergency department: correctness matters

Masayuki Amano; Yukinori Harada; Taro Shimizu

doi:10.1515/dx-2024-0121

Article

Impact of disclosing a working diagnosis during simulated patient handoff presentation in the emergency department: correctness matters

Masayuki Amano , Yukinori Harada and Taro Shimizu

Published/Copyright: October 16, 2024

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From the journal Diagnosis Volume 12 Issue 1

Abstract

Objectives

Diagnostic errors in emergency departments (ED) are a significant concern and exacerbated by cognitive biases during patient handoffs. The timing and accuracy of disclosing working diagnoses during these handoffs potentially influence diagnostic decisions, yet empirical evidence remains limited.

Materials and Methods

This parallel, quasi-experimental study involved 40 interns from Japanese teaching hospitals, randomly assigned to control or intervention groups. Each group reviewed eight audio-recorded patient handoff scenarios where working diagnoses were disclosed at the start (control) or end (intervention). Four cases presented correct diagnoses, while four featured incorrect ones. The main measure was diagnostic error rate, calculated as the proportion of incorrect post-handoff responses to total questions asked.

Results

No significant difference in diagnostic error rates emerged between the control (39.4 %, 63/160) and intervention (38.8 %, 62/160) groups (point estimate −0.6 %; 95 % CI: −11.3–10.1 %, p=0.91). However, a substantial difference was evident between diagnostic errors after correct (20.6 %, 33/160) and incorrect (57.5 %, 92/160) working diagnoses presented (point estimate: 36.9 %; 95 % CI: 27.0–46.8 %, p<0.001). Diagnostic momentum accounted for 52 % (48/92) of errors under incorrect diagnoses.

Conclusions

While the timing of working diagnosis disclosure did not significantly alter diagnostic accuracy during ED handoffs, exposure to incorrect diagnoses markedly increased error rates. These findings underscore the imperative to refine diagnostic skills and reconsider ED handoff protocols to mitigate cognitive biases and optimize patient care outcomes.

Keywords: patient handsoff; diagnostic excellence; diagnostic momentum; emergency department; working bias

Corresponding author: Taro Shimizu, MD, MSc, MPH, MBA, PhD, Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, 880, Kitakobayasshi, Mibu 321-0923, Tochigi, Japan, E-mail: shimizutaro7@gmail.com

Research ethics: Research involving human subjects complied with all relevant national regulations, institutional policies and is in accordance with the tenets of the Helsinki Declaration (as revised in 2013) and has been approved by the Bioethics Committee of Dokkyo Medical University (2021-028) and registered with UMIN-CTR (trial registration number: UMIN000050484).
Informed consent: Informed consent was obtained from all individuals included in this study, or their legal guardians or wards.
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Conflict of interest: The authors state no conflict of interest.
Research funding: None declared.
Data availability: The raw data can be obtained on request from the corresponding author.

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Supplementary Material

This article contains supplementary material (https://doi.org/10.1515/dx-2024-0121).

Received: 2024-07-10

Accepted: 2024-09-15

Published Online: 2024-10-16

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Supplementary Material

Articles in the same Issue

https://doi.org/10.1515/dx-2024-0121

Keywords for this article

patient handsoff; diagnostic excellence; diagnostic momentum; emergency department; working bias