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Table 1 List of generic checklists aimed to minimize cognitive errors in clinical setting

From: A portable mnemonic to facilitate checking for cognitive errors

Author(s), Year Description Reference
Graber et al. (2014) A generic checklist developed to reduce risk of diagnostic errors. The checklist consists of 2 parts. The first part contains 10 reflective questions aimed to identify high risk situations for diagnostic error: (1) Are there “must-not-miss” diagnoses that need consideration? (2) Did I just accept the first diagnosis that came to mind? (3) Was the diagnosis suggested to me by the patient, nurse, or another MD? (4) Is there data about this patient I haven’t obtained and reviewed? Old records? Family? Primary care provider? (5) Are there any piece pieces that don’t fit? (6) Did I read the X-ray myself? (7) Was this patient handed off to me from a previous shift? (8) Was this patient seen in the ER or clinic recently for the same problem? (9) Was I interrupted/distracted/cognitively overloaded while evaluating this patient? (10) Is this a patient I don’t like for some reason? Or like too much? (friend, relative). A “Yes” response to any of the questions puts the clinician at high risk for error. The second part suggests 3 things to do in high risk situations: (1) Pause to reflect—take a diagnostic “time-out” (2) Consider the universal antidote: What else could this be? (3) Make sure the patient knows when and how to get back to you if necessary [20]
Ely et al. (2011) This generic checklist consists of 5 steps: (1) Obtain your own complete medical history (2) Perform a focused and purposeful physical exam (3) Generate and differentiate initial hypotheses with further history, physical exam, and diagnostic tests (4) Pause to reflect—take a diagnostic “time-out” by asking the following five questions: (a) Was I comprehensive? (b) Did I consider the inherent flaws of heuristic thinking (c) Was my judgment affected by any other bias? (d) Do I need to make the diagnosis now, or can I wait? (e) What is the worst-case scenario? (5) Embark on a plan, but acknowledge uncertainty and ensure a pathway for follow-up [21]
Leo Leonidas’ ten commandments to reduce cognitive errors as quoted in Graber (2009) The ten commandments are: (1) Thou shalt reflect on how you think and decide. (2) Thou shalt not rely on your memory when making critical decisions. (3) Thou shalt make your working environment information-friendly by using the latest wireless technology such as the tablet PC and PDA. (4) Thou shalt consider other possibilities even though you are sure of your first diagnosis. (5) Thou shalt know Bayesian probability and the epidemiology of the diseases in your differential diagnosis. (6) Thou shalt mentally rehearse common and serious conditions that you expect to see in your specialty. (7) Thou shalt ask yourself if you are the right person to make the final decision or a specialist after considering the patient’s values and wishes. (8) Thou shalt take time to decide and not be pressured by anyone. (9) Thou shalt create accountability procedures and follow up for decisions made. (10) Thou shalt record in a relational data base software your patient’s problems and decisions for review and improvement [4]
Mamede et al. (2008) A 11-step checklist aimed to improve diagnostic accuracy by reflective practice. The 11 steps are: (1) Read the case again (2) Write down the hypothesis previously indicated again (3) List findings that support this hypothesis (4) List findings that oppose it (5) List findings that would be expected if the hypothesis-at-hand were true but which were not encountered in the case. (6) List alternative hypotheses if the first hypothesis proved to be incorrect. For each of these alternative hypotheses generated from step (6), then (7) list findings consistent with the hypothesis (8) list findings that contradicted the hypothesis (9) list findings that were expected but not present in the case. Based on this analysis, then (10) indicate your conclusions by ranking diagnostic hypotheses in order of likelihood and (11) present a final diagnosis [19]