Lecture 12: Learning from diagnostic errors
Goal: Understand how to develop and implement a system to learn from diagnostic errors
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Lecture 12 Pretest

Which of the following in NOT an effective approach to identifying diagnostic errors?

  1. Multidisciplinary conferences
  2. Radiology-Pathology correlation
  4. Nonrandom peer review

How many hours can be worked by residents in a continuous overnight call shift before there is a statistically significant increase in diagnostic errors?

  1. 8
  2. 10
  3. 12
  4. 14

Which of the following is an effective strategy to identify contributing factors when applied to analyzing diagnostic errors?

  1. Failure modes and effects analysis
  2. Value stream mapping
  3. Pareto chart
  4. Root cause analysis

What should a radiologist do when he identifies a missed sternal fracture on a chest CT interpreted by a resident overnight, and the patient has already been discharged?

  1. Document the discrepancy in the final report
  2. Call the ER but don’t document the discrepancy in the final report to protect the resident
  3. Call the ER and document communication of the sternal fracture in the final report
  4. Send the case to the residency program director

Which of the following is a recommendation for radiologists to reduce the risk of a malpractice claim?

  1. Implement over-read and second-evaluation processes that occur on an ongoing basis with feedback given to radiologists
  2. Encourage the use of phrases such as“when appropriate” when making recommendations about follow-up imaging
  3. Ensure that practices are using a random peer review process such as RADPEER to document errors rates
  4. Avoid using teleradiology or nighthawk services to read overnight studies

Which of the following is the best criteria for identification of peritoneal metastasis in patients with ovarian cancer?

  1. Presence of ascites
  2. Parietal peritoneal thickening
  3. Small bowel wall thickening
  4. Nodular soft tissue lesion on the peritoneal surface

Which of the following strategies can be used by radiologists when they are interpreting a study and the data are not fitting together?

  1. Recommend another imaging study
  2. Consult a colleague
  3. Leave exam for someone else to interpret
  4. Follow-up case to determine if an error was made

Which of the following is a type of cognitive bias?

  1. Edge of the film error
  2. Alliterative error
  3. Communication error
  4. Perceptual error

Framing bias:

  1. Reflects the undue influence that an initial interpretation has on the evaluation of subsequently collected information
  2. Results from a tendency to be influenced by how a question is asked or how a problem is presented
  3. Refers to the tendency for diagnostic assessments to be unduly influenced by easily recalled experiences
  4. Represents the influence that one radiologist’s judgment can exert on the diagnostic thinking of another radiologist

Which of the following is a system-related cause of diagnostic error?

  1. Hindsight bias
  2. Alliterative error
  3. Case complexity
  4. Workload
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