When a patient arrives at the emergency department, the correct diagnosis is critical to ensuring appropriate treatment.

Trial One

Improving Medical Diagnosis

Misdiagnosis can happen.

Hospital emergency departments are busy and chaotic environments. There is an increased risk that cognitive biases - the mental shortcuts we all use every day - influences clinicians’ decision making, leading to misdiagnosis, poor patient outcomes and even death.

The aim of this behaviour change trial was to test the effectiveness of a structured discussion between two clinicians about their independent diagnoses for reducing cognitive bias.

Learn more about the problem here.

The Rapid Diagnosis Discussion tool

Patients presenting to the ED with abdominal pain were first examined by one doctor then independently reviewed by another doctor. The two doctors then had a prompted, short discussion about their working diagnoses before proceeding with patient management.

Question prompts were:
- ‘What else could this be?’
- ‘Are there any symptoms or signs that don’t fit? Any red flags?’
- ‘Are any additional tests/investigations needed or do you already have
sufficient confidence in the diagnosis to proceed without them?’
- ‘Do we have all the relevant information about the patient?’

The trial involved three hospital emergency departments. One hospital used the RaDD tool and two didn’t (the control groups).

Learn more about the strategies here.

Aided discussion can reduce misdiagnosis.

We found that two heads are better than one - RaDD was shown to be an effective tool for reducing cognitive bias and improving communication between clinicians.

Of the 155 patients enrolled in RaDD, the original working diagnosis of the first doctor was changed in almost a quarter (24.7%) of cases. Clinician confidence in diagnosis increased and use of RaDD led to less patients being discharged home.

Learn more about the strategies here.