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Review
. 2022 Jan;38(1):141-157.
doi: 10.1016/j.ccc.2021.07.003.

A Research Agenda for Diagnostic Excellence in Critical Care Medicine

Christina L Cifra  1 , Jason W Custer  2 , James C Fackler  3
Affiliations
Review

A Research Agenda for Diagnostic Excellence in Critical Care Medicine

Christina L Cifra et al. Crit Care Clin. 2022 Jan.

Abstract

Diagnosing critically ill patients in the intensive care unit is difficult. As a result, diagnostic errors in the intensive care unit are common and have been shown to cause harm. Research to improve diagnosis in critical care medicine has accelerated in past years. However, much work remains to fully elucidate the diagnostic process in critical care. To achieve diagnostic excellence, interdisciplinary research is needed, adopting a balanced strategy of continued biomedical discovery while addressing the complex care delivery systems underpinning the diagnosis of critical illness.

Keywords: Critical care; Diagnosis; Diagnostic error; Intensive care unit; Misdiagnosis; Patient safety.

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Figures

Figure 1.
Figure 1.. Disease-Specific and Sociotechnical Aspects of the Diagnostic Process
Sociotechnical factors (work system) underpin the diagnostic process and must be considered alongside disease-specific considerations in order to improve the diagnosis of critical illness. Illustration by Ani Rofiqah, https://thenounproject.com/
Figure 2.
Figure 2.. Complexity and Challenges in Critical Care Diagnosis
Adapted with permission of the American Thoracic Society. Copyright © 2021 American Thoracic Society. All rights reserved. Bergl PA, et al. Diagnostic Error in the Critically III: Defining the Problem and Exploring Next Steps to Advance Intensive Care Unit Safety. Ann Am Thorac Soc. 2018;15(8):903-907. Annals of the American Thoracic Society is an official journal of the American Thoracic Society. Readers are encouraged to read the entire article for the correct context at https://www.atsjournals.org/doi/full/10.1513/AnnalsATS.201801-068PS. The authors, editors, and The American Thoracic Society are not responsible for errors or omissions in adaptations.
Figure 3.
Figure 3.. Unavoidable Diagnostic Errors
Failures in the diagnostic process leading to failure to identify a known disease is a preventable diagnostic error. Sometimes, clinicians fail to identify a disease because of inadequate scientific knowledge, which then causes unavoidable diagnostic errors. With scientific advances over time, diagnostic errors in this category should decrease. Reprinted with permission from De Gruyter. Newman-Toker DE. A unified conceptual model for diagnostic errors: underdiagnosis, overdiagnosis, and misdiagnosis. Diagnosis. 2014;1:43-48
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