Diagnostic Excellence in the ICU: Thinking Critically and Masterfully, An Issue of Critical Care Clinics

Cover image

Title page

Table of Contents

Copyright

Contributors

Forthcoming Issues

Preface

Diagnostic Error: Why Now?

Key points

Introduction

Definition

Measurement

Recommendations from 2015 national academy of medicine report

Summary

Clinics care points

Diagnostic Error in the Critically Ill: A Hidden Epidemic?

Key points

Introduction

Autopsies and the epidemiology of diagnostic errors among the critically ill

Estimating the frequency of diagnostic error in the intensive care unit using other methods

Broader epidemiologic trends in diagnostic error

Risk factors posited or known to be associated with diagnostic errors in the intensive care unit

Summary

Clinics care points

Dual Process Theory and Cognitive Load: How Intensivists Make Diagnoses

Key points

Introduction

Models of diagnostic reasoning

Cognitive load theory

Diagnostic uncertainty in the intensive care unit

Finding balance

Strategies for switching between systems

Summary

Clinics care points

Disclosure

Decision Making: Healthy Heuristics and Betraying Biases

Key points

Introduction

Background: how decisions are made

System 1 thinking and medical decision making

Heuristics and bias

Healthy heuristics

Heuristic failures and cognitive biases

Cognitive dispositions to respond

Determinants of cognitive dispositions to respond

Mitigating cognitive bias

Bias research and future directions

Summary

Clinics care points

Enhancing Analytical Reasoning in the Intensive Care Unit

Key points

Introduction

Errors in judgment and mathematical underpinnings

Mathematical concepts

Noise

Summary

Clinics care points

Diagnostic Stewardship: Appropriate Testing and Judicious Treatments

Key points

Introduction

What is diagnostic stewardship?

Stewardship of key infectious syndromes in the ICU

Bloodstream infections and blood cultures

Urinary tract infection testing

Tracheal cultures and ventilator-associated pneumonia

Clostridioides difficile (formerly Clostridium difficile) colonization and infection

Central nervous system infections

Stewardship during an infectious pandemic

Broader lessons learned from antimicrobial stewardship

Stewardship teams? Or diagnostic safety teams?

Stewardship, overdiagnosis, and related concepts

Diagnostic stewardship on the frontier of critical care

Clinics care points

Intensive Care Unit Decision-Making in Uncertain and Stressful Conditions Part 2: Cognitive Errors, Debiasing Strategies, and Enhancing Critical Thinking

Key points

Introduction

Why do cognitive errors occur?

Strategies to reduce cognitive errors

Systems-based strategies to reduce cognitive errors

Individual educational strategies to reduce cognitive error

Limitations to debiasing strategies

Teaching critical thinking in the intensive care unit

Summary

Conflicts of interest

Learning from Missed Opportunities Through Reflective Practice

Key points

Introduction

Definitions

Discussion

Summary

Clinics care points

Promoting Critical Thinking in Your Intensive Care Unit Team

Key points

Introduction

Summary

Clinics care points

Enhancing Diagnosis Through Technology: Decision Support, Artificial Intelligence, and Beyond

Key points

Introduction

Types of clinical decision support

Categories of diagnostic decisions applications of clinical decision support

Implementation issues

Future directions and opportunities for clinical decision support in intensive care units

Summary

Disclosure

A Research Agenda for Diagnostic Excellence in Critical Care Medicine

Key points

Introduction

Gaps in diagnosis research in critical care

A proposed research agenda

Summary

Clinics care points