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. 2020 Jan:82:102965.
doi: 10.1016/j.apergo.2019.102965. Epub 2019 Oct 9.

Reducing delays to diagnosis in ambulatory care settings: A macrocognition perspective

Emily S Patterson  1 , George Su  2 , Urmimala Sarkar  3
Affiliations

Reducing delays to diagnosis in ambulatory care settings: A macrocognition perspective

Emily S Patterson et al. Appl Ergon. 2020 Jan.

Abstract

We aim to use a macrocognition theoretical perspective to characterize contributors to diagnostic delays by physicians that can be mitigated by work system redesign. As experienced with other complex, sociotechnical domains, system redesign is anticipated to be more effective at improving safety than training-based solutions. In the outpatient care setting, complex tasks, conducted by a primary care provider, are provided for five macrocognition functions: sensemaking, re-planning, detecting problems, deciding, and coordinating. Redesigning systems could reduce delays to diagnosis by helping users to avoid missed symptoms, forgotten follow-up activities, and delayed actions. Health information technology could support resilience strategies by offloading documentation burdens, recording working diagnoses, displaying planned follow-up activities at the correct time interval, and supporting recognition of patterns in patient care. These insights suggest a path forward for future research on system design innovations to reduce diagnostic delays, and ultimately, reduce patient harm.

Keywords: Ambulatory care; Delayed diagnosis; Human factors; Medical informatics; Patient harm.

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Conflict of interest statement

Competing interests statement: The authors have no competing interests to declare.

Figures

Figure 1:
Figure 1:
Relationship of complex tasks, macrocognition functions, vulnerabilities, and resilience strategies to delays in diagnosis.
See this image and copyright information in PMC

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