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SAFER PRACTICES: reducing the risk of diagnostic errors

02 February 2020
17 min read
Volume 31 · Issue 2


Diagnostic errors are relatively common in general practice. Paul Silverston describes a mnemonic-based system to prevent and detect these errors

Diagnostic errors in primary care are relatively common and they have the potential to cause serious harm to patients. Up to 80% of these errors are believed to be preventable. This article describes a mnemonic-based system that practice nurses can use to prevent diagnostic errors from arising, as well as to detect these errors when they occur. The mnemonic is designed to be used pre-consultation to reduce the risk of errors arising through better preparation; during the consultation, as a diagnostic error checklist; and after the consultation to encourage reflective practice and critical thinking.

Over the past decade, a number of studies have been published on the subject of diagnostic error in primary care (Newman-Toker and Makary, 2013; Singh et al, 2017). The consensus is that not only are errors in diagnosis relatively common in primary care but they frequently result in serious harm to patients (Auraaen et al, 2018). Of particular significance is that it has been estimated that up to 80% of diagnostic errors are avoidable. In 2016, this led the World Health Organization (WHO) to declare that reducing the risk of diagnostic errors in primary care should be considered a global priority and that ‘Training focused on the causes and impact of diagnostic error might help providers become more competent in error prevention’ (WHO, 2016).

There are a number of different causes of errors in diagnosis, so a multi-faceted approach to the prevention and detection of diagnostic errors is required (Health Research and Educational Trust, 2018). In the aviation industry, checklists are used routinely and systematically to prevent and detect both system and human errors. The same approach has been adopted in the operating theatre to reduce the risk of treatment errors, where checklists have been embedded into treatment plans to both prevent and detect treatment errors. Checklists have also been used during consultations to prevent and detect diagnostic errors (Ely et al, 2011), including in the emergency department (Graber et al, 2014). However, while some diagnostic errors can be avoided through the use of diagnostic checklists, others can only be prevented by better pre-consultation preparation, or by the use of reflective practice and critical thinking post-consultation. This article describes a mnemonic, SAFER PRACTICES (Box 1), which is designed to bring a symptom-based, patient safety-focused approach to the diagnostic process, in a way that is integrative and systematic (Silverston, 2019).

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