References

Auraaen A, Slawomirskii L, Klazinga N. The economics of patient safety in primary and ambulatory care: Flying blind. OECD Health Working Papers. 2018; (106) https://doi.org/10.1787/18152015

Barnet Clinical Commissioning Group. Barnet primary care guide during COVID-19. http://primarycarepathways.co.uk/covid-19/clinical-assessment/pathways/177-barnet-primary-care-pathway-during-covid19-v2-0-pdf/file (accessed 8 April 2020)

British Thoracic Society. BTS guidance on venous thromboembolic disease in patients with COVID-19 v1.1. https://www.brit-thoracic.org.uk/about-us/covid-19-information-for-the-respiratory-community/ (accessed on 26 April 2020)

Covid-19: a remote assessment in primary care. [Infographic]. 2020; 368 https://doi.org/10.1136/bmj.m1182

Cheema M, Aghazadeh H, Nazarali S. Keratoconjunctivitis as the initial medical presentation of the novel coronavirus disease 2019 (COVID-19). Canadian Opthalmalogical Society. 2020; https://doi.org/10.1016/j.jcjo.2020.03.003

Chen T, Wu D, Chen H Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study. BMJ. 2020; 368 https://doi.org/10.1136/bmj.m1091

Chia-Jui S, Chih-Hung L. Viral exanthema in COVID-19: a clinical enigma with biological significance. Journal of the European Academy of Dermatology and Venereology. 2020; https://doi.org/10.1111/jdv.16469

Davoodi L, Taghavi M, Razavi A. Covid-19 presented with deep vein thrombosis: an unusual case report. Researchsquare. 2020; https://doi.org/10.21203/rs.3.rs-21602/v1

Ely JW, Graber ML, Croskerry P. Checklists to reduce diagnostic errors. Academic Medicine. 2011; 86:(3)307-313 https://doi.org/10.1097/ACM.0b013e31820824cd

Graber ML, Sorensen AV, Biswas J Developing checklists to prevent diagnostic error in Emergency Room settings. Diagnosis (Berl). 2014; 1:(3)223-231 https://doi.org/10.1515/dx-2014-0019

Greenhalgh T, Koh G, Car J. COVID-19: a remote assessment in primary care. BMJ. 2020; 368 https://doi.org/10.1136/bmj.m1182

Digestive symptoms in COVID-19 patients with mild disease severity: clinical presentation, stool viral RNA testing and outcomes. 2020. https://journals.lww.com/ajg/Documents/COVID19_Han_et_al_AJG_Preproof.pdf (accessed 16 April 2020)

Mao L, Jin H, Wang M. Neurological manifestations of hospitalised patients with coronavirus 2019 disease in Wuhan, China. JAMA Neurology. 2020; https://doi.org/10.1001/jamaneurol.2020.1127

NHS. General practice in the context of coronavirus (COVID-19). 2020. https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/03/C0133-COVID-19-Primary-Care-SOP-GP-practice_V2.1_6-April.pdf (accessed 24 April 2020)

National Institute for Health and Care Excellence. COVID-19 rapid guideline: managing symptoms in the community. NICE guideline 163. 2020. https://www.nice.org.uk/guidance/ng163 (accessed on 24 April 2020)

Newman-Toker D, Makary MA. Measuring diagnostic errors in primary care: the first step on a path forward. Comment on ‘Types and origins of diagnostic errors in primary care settings’. JAMA Internal Medicine. 2013; 173:(6)425-426 https://doi.org/10.1001/jamainternmed.2013.225

Newman-Toker D, Schaffer AC, Yu-Moe CW Serious misdiagnosis-related harms in practice: the ‘big three’: vascular events, infections and cancers. Diagnosis (Berl). 2019; 6:(3)227-240 https://doi.org/10.1515/dx-2019-0019

Norman GR, Monteiro SD, Sherbino J, Ilgen JS, Schmidt HG, Mamede S. The causes of errors in clinical reasoning: cognitive biases, knowledge deficits, and dual process thinking. Academic Medicine. 2017; 92:(1)23-30 https://doi.org/10.1097/ACM.0000000000001421

Primary Care Pathways. COVID 19 information. http://primarycarepathways.co.uk/covid19 (accessed 8 April 2020)

Public Health England. Guidance on shielding and protecting people who are clinically extremely vulnerable from COVID-19. https://www.gov.uk/government/publications/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19 (accessed on 16 April 2020)

Pygall SA. Telephone triage and consultation: are we really listening?.: Royal College of General Practitioners: RCGP Learning; 2017

Recalcati S. Cutaneous manifestations in COVID-19: a first perspective. Journal of the European Academy of Dermatology and Venereology. 2020; https://doi.org/10.1111/jdv.16387

Royce CS, Hayes MM, Schwartzstein RM. Teaching critical thinking: a case for instruction in cognitive biases to reduce diagnostic errors and improve patient safety. Academic Medicine. 2019; 94:(2)187-194 https://doi.org/10.1097/ACM.0000000000002518

Silverston P. The safe clinical assessment: a patient safety focused approach to clinical assessment. Nurse Education Today. 2013; 34:(2)214-217 https://doi.org/10.1016/j.nedt.2013.03.001

Silverston P, Stewart L. Diagnosis: uncertain. Student BMJ. 2014a; 22:28-29 https://doi.org/10.1136/sbmj.g1674

Silverston P. Effective safety-netting in prescribing practice. Nurse Prescribing. 2014b; 12:(7)1-4 https://doi.org/10.12968/npre.2014.12.7.349

Silverston P. Teaching patient-centred safety-netting in primary care. Journal of Community Medicine and Health Education. 2016; 6:(3) https://doi.org/10.4172/2161-0711.1000447

Silverston P. SAFER PRACTICES: reducing the risk of diagnostic errors. Practice Nursing. 2020a; 31:(2)80-86 https://doi.org/10.12968/pnur.2020.31.2.80

Silverston P. SAFER: A mnemonic to improve safety-netting advice. Practice Nursing. 2020b; 31:(1)26-28 https://doi.org/10.12968/pnur.2020.31.1.26

World Health Organization. Diagnostic errors. 2016. https://apps.who.int/iris/bitstream/handle/10665/252410/9789241511636-eng.pdf (accessed 20 January 2020)

Wu P, Duan F, Luo C Characteristics of ocular findings of patients with coronavirus disease (COVID-19) in Hubei Province, China. JAMA Ophthalmology. 2020; https://doi.org/10.1001/jamaophthalmol.2020.1291

Yan C, Faraji F, Prajapati D Association of chemosensory dysfunction and COVID-19 in patients presenting with influenza-like symptoms. International Forum of Allergy and Rhinology. 2020; https://doi.org/10.1002/alr.22579

Professional
Minor illness

SAFER PRACTICES in the COVID-19 pandemic

02 May 2020
Clinical Focus
02 May 2020
Volume 31 · Issue 5

Abstract

COVID-19 has created a wave of uncertainty for nurses and healthcare practitioners, with new information on the virus being released constantly. Paul Silverston discusses the assessment of patients with symptoms of COVID-19 and how to reduce the risk of misdiagnosis

Errors in diagnosis are relatively common in primary care which often result in serious harm to patients. The majority of these errors are preventable. This article describes a diagnostic error checklist, SAFER PRACTICES, which can be used to help clinicians prepare themselves for consulting in patients with suspected or confirmed COVID-19 disease so that they come to the consultation with the correct medical knowledge, clinical assessment plan and diagnostic reasoning required to reduce the risk of diagnostic error. It can also be used during the consultation to deliver a systematic approach to the prevention and detection of diagnostic errors.

Errors in diagnosis are relatively common in primary care and many of these errors result in serious harm to patients (Newman-Toker et al, 2013; Auraaen et al, 2018). However, up to 80% of diagnostic errors are considered to be preventable (World Health Organization [WHO], 2016). A mnemonic, SAFER PRACTICES (see Box 1), was created to bring together the most common causes of diagnostic error in primary care as a learning tool, as well as a diagnostic error checklist for use during the consultation (Silverston, 2020a). The emergence of the novel coronavirus COVID-19 has created a new set of problems for clinicians, including an increased risk of diagnostic error. This article describes why the COVID-19 pandemic may result in an increased risk of misdiagnosis in primary care and how SAFER PRACTICES can be used to reduce this risk.

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Diagnosis
Diagnostic errors
COVID-19
Patient safety