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Understanding diagnostic errors in medicine: a lesson from aviation

¹ Division of Health Policy and Quality, Houston Center for Quality of Care and Utilization Studies, Michael E DeBakey Veterans Affairs Medical Center and Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, Texas, USA
² University of Texas Center of Excellence for Patient Safety Research and Practice; Division of General Medicine, Department of Medicine, University of Texas Medical School at Houston, Texas, USA

Correspondence to:
Dr H Singh
VA Medical Center (152), 2002 Holcombe Blvd, Houston, TX 77030, USA;hardeeps{at}bcm.tmc.edu
ABSTRACT
The impact of diagnostic errors on patient safety in medicine is increasingly being recognized. Despite the current progress in patient safety research, the understanding of such errors and how to prevent them is inadequate. Preliminary research suggests that diagnostic errors have both cognitive and systems origins. Situational awareness is a model that is primarily used in aviation human factors research that can encompass both the cognitive and the systems roots of such errors. This conceptual model offers a unique perspective in the study of diagnostic errors. The applicability of this model is illustrated by the analysis of a patient whose diagnosis of spinal cord compression was substantially delayed. We suggest how the application of this framework could lead to potential areas of intervention and outline some areas of future research. It is possible that the use of such a model in medicine could help reduce errors in diagnosis and lead to significant improvements in patient care. Further research is needed, including the measurement of situational awareness and correlation with health outcomes.

Abbreviations: SA, situational awareness; SAGAT, Situation Awareness Global Assessment Technique

Keywords: diagnostic errors; situational awareness; aviation; human factors; decision making

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