Academic literature on the topic 'Clinical decision making;reasoning;judgement'
Create a spot-on reference in APA, MLA, Chicago, Harvard, and other styles
Consult the lists of relevant articles, books, theses, conference reports, and other scholarly sources on the topic 'Clinical decision making;reasoning;judgement.'
Next to every source in the list of references, there is an 'Add to bibliography' button. Press on it, and we will generate automatically the bibliographic reference to the chosen work in the citation style you need: APA, MLA, Harvard, Chicago, Vancouver, etc.
You can also download the full text of the academic publication as pdf and read online its abstract whenever available in the metadata.
Journal articles on the topic "Clinical decision making;reasoning;judgement"
1
Ward, Tony. "Method, Judgement, and Clinical Reasoning." Behaviour Change 16, no. 1 (April 1, 1999): 4–9. http://dx.doi.org/10.1375/bech.16.1.4.
Full textAbstract:
AbstractResearchers have tended to take one of two mutually exclusive positions concerning the nature and status of clinical decision-making. On the one hand, clinicians are urged to be more rigorous and analytical when assessing a client, to disregard their intuitions and instead utilise explicit rules and algorithms. On the other hand, they are counselled to regard their “gut feelings” as valuable sources of knowledge about clients. As a way of reconciling these two perspectives, it is important to acknowledge that clinical psychologists are confronted with a wide range of assessment and clinical tasks that vary in their degree of structure. Therefore, in order to effectively manage the diverse tasks they face during a typical assessment, they need to possess a wide range of cognitive skills. These skills, and their associated cognitive tasks, will span the cognitive continuum from the intuitive to the analytical poles (Hammond, 1996).
2
Gladstone, Nicholas. "Comparative Theories in Clinical Decision Making and their Application to Practice: a Reflective Case Study." British Journal of Anaesthetic and Recovery Nursing 13, no. 3-4 (August 2012): 65–71. http://dx.doi.org/10.1017/s1742645612000435.
Full textAbstract:
AbstractWithin this article the author critically reviews the theories surrounding clinical decision making and judgement while discussing a clinical incident, and his experiences of decision making within his own practice setting. Exploring the works of Elstein and Schwarz, Benner, Hammond and Hamm, the author discusses how aspects from each of their theories relate to his practice and clinical reasoning before concluding on the clinical decision-making process and factors that can influence their successful application.
3
Siegert, Richard J. "Some Thoughts About Reasoning in Clinical Neuropsychology." Behaviour Change 16, no. 1 (April 1, 1999): 37–48. http://dx.doi.org/10.1375/bech.16.1.37.
Full textAbstract:
AbstractThe present paper argues that discussion of the role of reasoning in clinical neuropsychology has been largely restricted to a debate over the reliability and validity of end-stage decision-making. This has sometimes led to heated debate, but has not resulted in any careful consideration of either the process of clinical reasoning or the cognition of the clinician. There is already a wealth of theory and research on the kinds of errors typical of human judgement and decision-making. Moreover, much of this work is particularly relevant for neuropsychology, being frequently based on research on medical diagnosis. This literature is briefly reviewed, with examples that demonstrate the relevance of research in this area for clinical neuropsychology. Then, a step-by-step approach is taken to examining the process of clinical neuropsychological assessment, with consideration at each step of some of the issues that arise demanding clinical reasoning. Finally, the article is briefly summarised and some implications for clinical training are advanced.
4
Ameen, Saleem, Ming-Chao Wong, Kwang-Chien Yee, and Paul Turner. "AI and Clinical Decision Making: The Limitations and Risks of Computational Reductionism in Bowel Cancer Screening." Applied Sciences 12, no. 7 (March 25, 2022): 3341. http://dx.doi.org/10.3390/app12073341.
Full textAbstract:
Advances in artificial intelligence in healthcare are frequently promoted as ‘solutions’ to improve the accuracy, safety, and quality of clinical decisions, treatments, and care. Despite some diagnostic success, however, AI systems rely on forms of reductive reasoning and computational determinism that embed problematic assumptions about clinical decision-making and clinical practice. Clinician autonomy, experience, and judgement are reduced to inputs and outputs framed as binary or multi-class classification problems benchmarked against a clinician’s capacity to identify or predict disease states. This paper examines this reductive reasoning in AI systems for colorectal cancer (CRC) to highlight their limitations and risks: (1) in AI systems themselves due to inherent biases in (a) retrospective training datasets and (b) embedded assumptions in underlying AI architectures and algorithms; (2) in the problematic and limited evaluations being conducted on AI systems prior to system integration in clinical practice; and (3) in marginalising socio-technical factors in the context-dependent interactions between clinicians, their patients, and the broader health system. The paper argues that to optimise benefits from AI systems and to avoid negative unintended consequences for clinical decision-making and patient care, there is a need for more nuanced and balanced approaches to AI system deployment and evaluation in CRC.
5
Hahn, Sukwon, and Young Mi Ryu. "Trends in research on clinical reasoning in nursing over the past 20 years: a bibliometric analysis." Science Editing 9, no. 2 (August 19, 2022): 112–19. http://dx.doi.org/10.6087/kcse.276.
Full textAbstract:
Purpose: Clinical reasoning is an essential component of nursing education. This study aimed to identify the trends in research on clinical reasoning in nursing over a 22-year period.Methods: The Web of Science Core Collection was used as the target database, with the search terms “clinical reasoning,” “clinical judgement,” and “clinical decision.” The scope of the search included the subject, abstract, author’s keywords, and Keywords Plus for each article. Our literature search included journal articles from 2000 to 2021, with the subject area restricted to nursing. A total of 4,675 articles met the inclusion criteria after the removal of duplicates using digital object identifier. We used bibliometric analyses to conduct quantitative and statistical analyses of publication trends, the journals and countries with the most publications, the most productive authors, the most globally cited documents, and the most frequent keywords.Results: In nursing, studies related to clinical reasoning have increased significantly since 2000. The most prolific country has been the United States. The journal with the most publications was the <i>Journal of Clinical Nursing</i>. The most productive author was Considine J, with 23 publications. The most widely cited author was Tanner CA, with 614 citations. The most frequent keywords in the literature related to clinical reasoning were “care,” “nurses,” and “decision-making,” in that order.Conclusion: This study examined the quantitative analysis and statistics of publications related to clinical reasoning in nursing in the past 20 years using bibliographic information. This study can help guide future research on clinical reasoning for nurse educators.
6
Besa, Chola, G. Chongo, and N. Cooper. "Cognitive Autopsy of a Fatal Diagnostic Error." Medical Journal of Zambia 46, no. 4 (December 31, 2019): 357–61. http://dx.doi.org/10.55320/mjz.46.4.609.
Full textAbstract:
Background: Diagnostic error is a significant cause of preventable harm worldwide and diagnostic errors have been identified as a high priority patient safety problem by the World Health Organization. Research shows thatdiagnostic error occurs mainly due to system failures and 'cognitive errors' – that is, failure to synthesise all the available information. There is a worldwide consensus that medical schools and postgraduate training programmes rarely teachthe diagnostic process and related decision making (clinical reasoning) in a way that is explicit, systematic and consistent with what is known from research.
Materials and methods: This paper presents a short case report and analyses it from a clinical reasoning perspective – performing a 'cognitive autopsy' of a fatal diagnostic error.
Results: Clinicians make cognitive shortcuts through pattern recognition and this is highly accurate most of the time. However, shortcuts sometimes go wrong and these are termed 'cognitive biases'. Cognitive biases are subconscious errors of judgement or perception and common examples include 'anchoring', 'the framing effect', 'search satisficing 'and' confirmation biases. These errors are more likely when clinicians are fatigued or cognitively overloaded, and when systems are not designed to mitigate human errors.
Conclusions: There is a vast literature on clinical reasoning, 'human factors', and reflection during decision making that show us how we can reduce diagnostic error in our everyday practice. This paper attempts to highlight some of the key findings in the literature that will hopefully encourage readers to explore the patient safety and clinical reasoning literature for themselves and work together to improve outcomes for patients.
7
Oliva, Antonio, Simone Grassi, Massimo Zedda, Marco Molinari, and Stefano Ferracuti. "Forensic Value of Genetic Variants Associated with Anti-Social Behavior." Diagnostics 11, no. 12 (December 17, 2021): 2386. http://dx.doi.org/10.3390/diagnostics11122386.
Full textAbstract:
Insanity defense is sometimes invoked in criminal cases, and its demonstration is usually based on a multifactorial contribution of behavioural, clinical, and neurological elements. Neuroradiological evidence of structural alterations in cerebral areas that involve decision-making and moral reasoning is often accepted as a useful tool in these evaluations. On the other hand, the genetic predisposition to anti-social behavior is still controversial. In this paper, we describe two cases of violent crimes committed by young carriers of genetic variants associated with personality disorder; both the defendants claimed to be insane at the time of the crime. We discuss these cases and review the scientific literature regarding the relationship between legal incapacity/predisposition to criminal behavior and genetic mutations. In conclusion, despite some genetic variants being able to influence several cognitive processes (like moral judgement and impulse control), there is currently no evidence that carriers of these mutations are, per se, incapable of intentionally committing crimes.
8
Dowie, Jack. "The ‘Number Needed to Treat’ and the ‘Adjusted NNT’ in Health Care Decision-Making." Journal of Health Services Research & Policy 3, no. 1 (January 1998): 44–49. http://dx.doi.org/10.1177/135581969800300110.
Full textAbstract:
Within ‘evidence-based medicine and health care’ the ‘number needed to treat’ (NNT) has been promoted as the most clinically useful measure of the effectiveness of interventions as established by research. Is the NNT, in either its simple or adjusted form, ‘easily understood’, ‘intuitively meaningful’, ‘clinically useful’ and likely to bring about the substantial improvements in patient care and public health envisaged by those who recommend its use? The key evidence against the NNT is the consistent format effect revealed in studies that present respondents with mathematically-equivalent statements regarding trial results. Problems of understanding aside, trying to overcome the limitations of the simple (major adverse event) NNT by adding an equivalent measure for harm (‘number needed to harm’ NNH) means the NNT loses its key claim to be a single yardstick. Integration of the NNT and NNH, and attempts to take into account the wider consequences of treatment options, can be attempted by either a ‘clinical judgement’ or an analytical route. The former means abandoning the explicit and rigorous transparency urged in evidence-based medicine. The attempt to produce an ‘adjusted’ NNT by an analytical approach has succeeded, but the procedure involves carrying out a prior decision analysis. The calculation of an adjusted NNT from that analysis is a redundant extra step, the only action necessary being comparison of the results for each option and determination of the optimal one. The adjusted NNT has no role in clinical decision-making, defined as requiring patient utilities, because the latter are measurable only on an interval scale and cannot be transformed into a ratio measure (which the adjusted NNT is implied to be). In any case, the NNT always represents the intrusion of population-based reasoning into clinical decision-making.
9
Silvério Rodrigues, David, Paulo Faria Sousa, Nuno Basílio, Ana Antunes, Maria da Luz Antunes, Maria Isabel Santos, and Bruno Heleno. "Primary care physicians’ decision-making processes in the context of multimorbidity: protocol of a systematic review and thematic synthesis of qualitative research." BMJ Open 9, no. 4 (April 2019): e023832. http://dx.doi.org/10.1136/bmjopen-2018-023832.
Full textAbstract:
IntroductionGood patient outcomes correlate with the physicians’ capacity for good clinical judgement. Multimorbidity is common and it increases uncertainty and complexity in the clinical encounter. However, healthcare systems and medical education are centred on individual diseases. In consequence, recognition of the patient as the centre of the decision-making process becomes even more difficult. Research in clinical reasoning and medical decision in a real-world context is needed. The aim of the present review is to identify and synthesise available qualitative evidence on primary care physicians’ perspectives, views or experiences on decision-making with patients with multimorbidity.Methods and analysisThis will be a systematic review of qualitative research where PubMed, CINAHL, PsycINFO, Embase and Web of Science will be searched, supplemented with manual searches of reference lists of included studies. Qualitative studies published in Portuguese, Spanish and English language will be included, with no date limit. Studies will be eligible when they evaluate family physicians’ perspectives, opinions or perceptions on decision-making for patients with multimorbidity in primary care. The methodological quality of studies selected for retrieval will be assessed by two independent reviewers before inclusion in the review using the Critical Appraisal Skills Programme (CASP) tool. Thematic synthesis will be used to identify key categories and themes from the qualitative data. The Confidence in the Evidence from Reviews of Qualitative research approach will be used to assess how much confidence to place in findings from the qualitative evidence synthesis.Ethics and disseminationThis review will use published data. No ethical issues are foreseen. The findings will be disseminated to the medical community via journal publication and conference presentation(s).PROSPERO registration numberID 91978.
10
Owen, Gareth S., George Szmukler, Genevra Richardson, Anthony S. David, Vanessa Raymont, Fabian Freyenhagen, Wayne Martin, and Matthew Hotopf. "Decision-making capacity for treatment in psychiatric and medical in-patients: Cross-sectional, comparative study." British Journal of Psychiatry 203, no. 6 (December 2013): 461–67. http://dx.doi.org/10.1192/bjp.bp.112.123976.
Full textAbstract:
BackgroundIs the nature of decision-making capacity (DMC) for treatment significantly different in medical and psychiatric patients?AimsTo compare the abilities relevant to DMC for treatment in medical and psychiatric patients who are able to communicate a treatment choice.MethodA secondary analysis of two cross-sectional studies of consecutive admissions: 125 to a psychiatric hospital and 164 to a medical hospital. The MacArthur Competence Assessment Tool – Treatment and a clinical interview were used to assess decision-making abilities (understanding, appreciating and reasoning) and judgements of DMC. We limited analysis to patients able to express a choice about treatment and stratified the analysis by low and high understanding ability.ResultsMost people scoring low on understanding were judged to lack DMC and there was no difference by hospital (P=0.14). In both hospitals there were patients who were able to understand yet lacked DMC (39% psychiatric v. 13% medical in-patients, P<0.001). Appreciation was a better ‘test’ of DMC in the psychiatric hospital (where psychotic and severe affective disorders predominated) (P<0.001), whereas reasoning was a better test of DMC in the medical hospital (where cognitive impairment was common) (P=0.02).ConclusionsAmong those with good understanding, the appreciation ability had more salience to DMC for treatment in a psychiatric setting and the reasoning ability had more salience in a medical setting.
Dissertations / Theses on the topic "Clinical decision making;reasoning;judgement"
1
Baker, Jacqueline Deborah. "Nurses' Perceptions of Clinical Decision Making in relation to Patients in Pain." University of Sydney. Family and Community Nursing, 2001. http://hdl.handle.net/2123/489.
Full textAbstract:
Clinical decision-making (CDM) research has focused on diagnostic reasoning, CDM models, factors influencing CDM and the development of expertise. The research approaches used, including phenomenology, have not addressed the question of how CDM is perceived and approached by nurses. This study describes perceptions of CDM in relation to patients in pain using a phenomenographic methodology. At semi-structured interviews, participants were asked to recall their responses to a situation involving a patient in pain. The responses fell into four categories: (1) the effect of the clinical environment; (2) the role of other health professionals; (3) the place of the patient; and (4) the role of experience. Examples of differences in perceptions that were likely to impact on the nurses� approach to CDM include: the ongoing effects of time and workload demands on CDM; nurses are initially dependent but were eventually able to make decisions autonomously; the patient who may be peripheral or central to CDM; and the nurses� move from the use of theoretical principles to experiential knowledge as reflection-on-practice is employed. Perceptions in all categories are strongly implicated in the nurses� sense of confidence and independence. Implications for nursing practice and nursing education suggested by the findings relate to the number of areas in which graduates work in the first year of practice, the size of new graduate workloads, graduate transition programs, the place of reflection-on-practice and undergraduate (UG) program clinical experience patterns. Among issues for further research arising from the study are: replication of the study; detailed examination of the development of CDM in the first year of nursing practice and during UG nursing education programs; the role of other health professionals in the development of CDM behaviour; the links between CDM and clinical knowledge development; and the type of clinical environments that foster confidence and independence. A conclusion of the study is that the way CDM is approached is influenced by the amount, quality, relevancy and recency of clinical experience. In this study, phenomenography was shown to be an appropriate approach to the description of nurses� perceptions of CDM in relation to patients in pain. In addition, nurses� changing perceptions over two years and the subsequent effect on CDM behaviour were described.
2
Harries, Priscilla Ann. "Occupational therapists' judgement of referral priorities : expertise and training." Thesis, Brunel University, 2004. http://bura.brunel.ac.uk/handle/2438/3110.
Full textAbstract:
The British government currently requires mental health services to be targeted at the most needy (Department of Health, 1999). For occupational therapy services, where service demand far exceeds service availability, skill in referral prioritisation is essential. The studies in this thesis describe how experienced occupational therapists’ referral prioritisation policies were used to successfully educate novices. 40 British occupational therapists’ referral prioritisation policies were modelled using judgement analysis. Individuals’ prioritisation decisions were regressed onto 90 referral scenarios to statistically model how referral information had been used. It was found that the reason for referral, history of violence and diagnosis were most important. The occupational therapists’ capacity for self-insight into their policies was also examined by comparing statistically modelled policies derived from their behaviour with their subjective view of their cue use. Self-insight was found to be moderate (mean r = 0.61). A Ward’s cluster analysis was used on the statistically modelled policies to identify if subgroups of therapists had differing referral prioritisation policies. Four clusters were found. They differed according to several factors including the percentage of role dedicated to specialist occupational therapy rather than generic work. The policies that led to more of an occupational therapy role were found to give particular importance to the reason for referral and the client’s diagnosis. The occupational therapy professional body supports this latter method of working as it has recommended that occupational therapists should use their specialist skills to ensure clients’ needs are met effectively. Therefore the policies that focussed on clients’ occupational functioning were used to train the novices. Thirty-seven students were asked to prioritise a set of referrals before and after being shown graphical and descriptive representations of the policies. Students gained statistically significant improvements in prioritisation. Students’ pre-training policies were found to be those of generic therapists; a method of working that has been found to be leading to reduced work satisfaction and burnout (Craik et al.1998b). The training is therefore needed to ensure undergraduate occupational therapy students develop effective referral prioritisation skills. This will help to ensure that clients’ needs are met most effectively and work stress is reduced.
3
Smith, Julie MacAulay. "The transition from Final Year Medical Student to Foundation Doctor : the clinical reasoning journey." Thesis, University of Dundee, 2015. https://discovery.dundee.ac.uk/en/studentTheses/ec05577b-d97e-45a2-b0fe-010fc5dd0835.
Full textAbstract:
Although clinical reasoning is both broad and complex, the term “clinical reasoning” is contested and multiple definitions have been mooted within different contexts. In its simplest form, clinical reasoning is regarded as a “decision-making” process. Other definitions outline it in terms of a complex cognitive process, posited within multiple contextual factors. Traditionally, clinical reasoning models have been based upon cognitive theories. More recently, interpretive theories have been applied. Despite extensive research over the past four decades, no consensus on how clinical reasoning actually occurs has been achieved. Accurate clinical reasoning is vital to patient safety. Its importance as an essential clinical competence for healthcare professionals is well established. Indeed, it is the crux of a clinician’s work. Frequently, Foundation doctors are the first to review acutely unwell patients. During out-of-hours shifts senior help can be scant and Foundation doctors may have to rely on their own initial clinical reasoning to manage acutely unwell patients. This PhD explores clinical reasoning development in the transition phase between final year medical student and Foundation doctor (5MB-FY1 transition) in relation to acutely unwell patients. It follows a cohort of final year medical students from a single UK university on their clinical reasoning journeys as they transition into Foundation doctors, focusing on the role of the simulated healthcare setting and the workplace. The principle research question for this PhD was how does clinical reasoning develop across the transition phase between final year of medical school and Foundation year one? Within this overarching research question, the following sub-questions were posed: What do participants understand by the term clinical reasoning? What types of clinical reasoning experiences do participants narrate? How do participants clinically reason for acutely unwell patients? Which factors do participants perceive as being facilitating and hindering to their clinical reasoning? How do participants’ clinical reasoning processes develop across the 5MB-FY1 transition phase? This PhD uses multiple methodologies derived from interpretive approaches in innovative ways to tap into clinical reasoning processes and its development across four data collection points: T1: group and individual interviews; T2: Ward Simulation Exercise observations and stimulated recall interviews; T3: workplace observations and stimulated recall interviews; T4: final interviews. Data were collected from T1/T2 and T3/T4 during the final year of medical school and Foundation year one respectively. Primary thematic analyses were carried out cross-sectionally and longitudinally in terms of what participants said and how they said it. Secondary narrative analyses were undertaken of participants’ Personal Incident Narratives. By taking an interpretive approach, the complexities of clinical reasoning processes, both in terms of internal cognition and external socio-cultural influences were illuminated, drawing upon clinical reasoning, complexity and situated learning theories. The key findings of this PhD were that participants conceptualised clinical reasoning as a “decision-making” and “thinking” process, leading to a clinical judgement for patient care; participants narratives aided understanding of clinical reasoning process and factors which facilitated and hindered them; participants used experiential knowledge and protocols to clinically reason for diagnosis, investigation, management and prioritisation; participants retained flexibility and contextual variability in the processes of making their clinical judgements; multiple factors facilitated and hindered the equilibrium of clinical judgement processes; and clinical reasoning development is dependent upon a complex interplay of individual, interpersonal and systemic factors which are deeply embedded in social-cultural theory. This study has multiple strengths and original features such the high participant retention rate throughout the longitudinal study, the exploration of the 5MB-FY1 transition, contemporaneous observations of clinical interactions with patients, the exploration of the out-of-hour setting contemporaneously and the multiple methods of data collection used in innovative ways. This PhD develops the published literature further in these domains. However, its challenges were predominantly ethical, such as lack of patient capacity to consent in the workplace.
4
Eiman, Johansson Maria. "Sjuksköterskors kliniska beslutsfattande med fokus på perifera venkatetrar (PVK)." Licentiate thesis, Malmö högskola, Institutionen för vårdvetenskap (VV), 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:mau:diva-7380.
Full textAbstract:
För att kunna ge vård av säker och god kvalitet krävs att sjuksköterskor har kunskap inom många områden, eftersom de har ansvar för såväl bedömning, planering och genomförande, som utvärdering och dokumentation av omvårdnadsarbetet. Ett av flera ansvarsområden för sjuksköterskor i deras dagliga arbete är beslutsfattande om insättning och skötsel av perifera venkatetrar (PVK). En PVK är en tunn plastkateter som sätts in i ett blodkärl via en kanyl. PVK används vid intravenös behandling med till exempel antibiotika och andra läkemedel, blodkomponenter eller näringslösningar. En stor andel av alla patienter inom hälsooch sjukvård kommer någon gång i kontakt med en PVK och riskerar då också att utsättas för komplikationer. En vanlig komplikation i samband med PVK är tromboflebit. Tromboflebit förekommer i olika svårighetsgrader och innebär att inflammation har uppstått i blodkärlet i kombination med samtidig blodpropp. Symtom som kan uppstå är rodnad, svullnad, smärta, hårdhet i kärlet och varig infektion. Det finns kliniska riktlinjer om PVK framtagna både på nationell och på lokal nivå som fungerar som ett stöd i beslutsfattandet. Tidigare forskning har visat att kliniskt verksamma ibland inte följer riktlinjer. Anledningar till att inte riktlinjer följs kan till exempel vara att de kliniskt verksamma inte håller med om det som rekommenderas, inte känner till rekommendationerna, inte har tid eller möjlighet att påverka de beslut som fattas eller att det finns individuella faktorer att ta hänsyn till för den enskilda patienten. 52 Frågan kan ställas om sjuksköterskor använder sig av kliniska riktlinjer i sitt dagliga arbete eller om det är andra faktorer och aspekter som har betydelse och påverkar beslutsfattandet. Denna licentiatavhandling syftade till att beskriva sjuksköterskors kliniska beslutsfattande genom att fokusera på deras följsamhet till riktlinjer och beslutsresonemang om PVK. Två studier har genomförts inom ramen för denna licentiatavhandling. Studie I undersökte i vilken utsträckning sjuksköterskor följer nationella och lokala riktlinjer om PVK. PVKns placering och storlek, tiden som PVKn varit placerad i blodkärlet, dokumentation vid PVKns förband samt om det fanns tecken på tromboflebit vid PVKn var variabler som undersöktes i relation till de rekommendationer som fanns. Utifrån två protokoll samlades strukturerad data in och analyserades. Totalt 343 PVK ingick i analysen. I studie II undersöktes de tecken och påverkande faktorer som har betydelse när sjuksköterskor fattar beslut om skötsel av PVK. I studien observerades 43 sjuksköterskor i sitt dagliga arbete. Sjuksköterskorna intervjuades också dels om PVK-besluten som de fattade under observationerna, dels om deras beslutsfattande om PVK-skötsel i allmänhet. Studie I visade att sjuksköterskor delvis följer riktlinjer. Det fanns skillnader mellan de vårdavdelningar som hade nationella riktlinjer och de som hade lokala riktlinjer, i hur de olika avdelningarna valde placering, storlek och dokumenterade vid PVKns förband. PVKn hade suttit längre tid än rekommenderat i varierande utsträckning. Andelen tromboflebiter var låg (7.0%) och tromboflebiterna var milda. Det tyder på att sjuksköterskor är noga med att ta bort PVK vid tecken på komplikationer. Studie II visade att sjuksköterskor i sitt kliniska resonemang om PVK-skötsel tar hänsyn till den individuella patientsituationen, sjuksköterskans arbetssituation och erfarenhet av PVK-skötsel. Det framkom även att sjuksköterskor balanserar mellan att undvika eller minimera obehag och smärta för patienten och samtidigt förebygga komplikationer från PVKn. Resultaten från denna licentiatavhandling kan få betydelse för undervisning av sjuksköterskestudenter och även när kliniska riktlinjer ska införas på vårdavdelningar.Every working shift nurses make several decisions, including decisions about management of peripheral venous catheters (PVC). Peripheral catheterisation is a common procedure, which affects numerous patients in health care today. PVC are for example used for intravenous infusions with antibiotics, nutrients and blood components. Having PVC in situ may lead to complications such as thrombophlebitis. Clinical guidelines have been developed within the area to assist nurses in their decision-making, but clinical guidelines are not always adhered to. There are several reasons why clinicians do not always adhere to clinical guidelines, although such adherence may lead to fewer complications. Choices for decisions regarding PVC management have been investigated in previous studies, but not in a naturalistic setting. The overall aim of this licentiate thesis was to describe nurses’ clinical decision-making through focusing on their adherence to clinical guidelines and their clinical reasoning concerning decisions of PVC. Two studies have been conducted and data were collected during a six-month period, from December 2004 to June 2005. Study I investigated nurses’ adherence to national and local PVC guidelines by focusing on time in situ, site, size and documentation at the dressing. The thrombophlebitis frequency associated with PVC in situ was also investigated. Structured observations through two protocols were carried out and data about 343 PVC were analysed. Study II investigated nurses’ clinical reasoning regarding PVC management and cues and factors of importance in the decision10 making process were analysed. Nurses were observed in their daily work with focus on PVC management. They were interviewed both about the PVC decisions made in the observed situations and about factors influencing their reasoning regarding PVC management in general. The observations facilitated the interviews. Transcribed interview texts were analysed with content analysis. The results in study I showed that thrombophlebitis frequency was 7.0% and the nurses seemed to replace or remove PVC before any severe complications arose in accordance with clinical guidelines. Nurses partly adhered to national and local guidelines concerning site, size, documentation at the dressing and time in situ. Differences in guideline adherence were observed for wards with local or national guidelines, as well as for wards with different specialities. The results indicate that local guidelines may have an impact on guideline adherence but these results need further exploration. Analysis of interview texts in study II resulted in a category system with three main categories describing cues and factors of importance in the nurses’ clinical reasoning about PVC: the individual patient situation, the nurse’s work situation, and experience of PVC management. An overall theme was also revealed in the interview texts and the nurses balance in their clinical reasoning between avoiding or minimizing discomfort and pain for the patient and preventing complications from the PVC. The results from this licentiate thesis have implications for the education of nurses as well as during implementation of clinical guidelines.
5
Cohen, Andrea. "A study of decision-making about risk of violence in mentally disordered offenders." Thesis, Open University, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.369030.
Full text
6
Loftus, Stephen Francis. "Language in clinical reasoning learning and using the language of collective clinical decision making /." Faculty of Health Sciences, School of Physiotherapy, University of Sydney, 2006. http://hdl.handle.net/2123/1165.
Full textAbstract:
Doctor of PhilosophyThe aim of the research presented in this thesis was to come to a deeper understanding of clinical decision making from within the interpretive paradigm. The project draws on ideas from a number of schools of thought which have the common emphasis that the interpretive use of language is at the core of all human activity. This research project studied settings where health professionals and medical students engage in clinical decision making in groups. Settings included medical students participating in problem-based learning tutorials and a team of health professionals working in a multidisciplinary clinic. An underlying assumption of this project was that in such group settings, where health professionals are required to articulate their clinical reasoning for each other, the individuals involved are likely to have insights that could reveal the nature of clinical decision making. Another important assumption of this research is that human activities, such as clinical reasoning, take place in cultural contexts, are mediated by language and other symbol systems, and can be best understood when investigated in their historical development. Data were gathered by interviews of medical students and health professionals working in the two settings, and by non-participant observation. Data analysis and interpretation revealed that clinical decision making is primarily a social and linguistic skill, acquired by participating in communities of practice called health professions. These communities of practice have their own subculture including the language game called clinical decision making which includes an interpretive repertoire of specific language tools and skills. New participants to the profession must come to embody these skills under the guidance of more capable members of the profession, and do so by working through many cases. The interpretive repertoire that health professionals need to master includes skills with words, categories, metaphors, heuristics, narratives, rituals, rhetoric, and hermeneutics. All these skills need to be coordinated, both in constructing a diagnosis and management plan and in communicating clinical decisions to other people, in a manner that can be judged as intelligible, legitimate, persuasive, and carrying the moral authority for subsequent action.
7
Agustsson, Hilmir. "Diagnostic Musculoskeletal Imaging: How Physical Therapists Utilize Imaging in Clinical Decision-Making." Diss., NSUWorks, 2018. https://nsuworks.nova.edu/hpd_pt_stuetd/72.
Full textAbstract:
This qualitative study describes how physical therapist experts in musculoskeletal disorders evaluate and interpret imaging studies and how they employ imaging in clinical decision-making. The informants are physical therapists who are certified orthopedic clinical specialists (OCS) and/or fellows of the American Academy of Orthopaedic Manual Physical Therapists (AAOMPT). The study employed web conferencing to display patient cases, record screen-capture videos, and to conduct interviews. Informants were observed and their activity video-captured as they evaluated imaging studies and, afterwards, interviews were employed to explore the processes they utilized to evaluate and interpret the images and to discuss imaging-related clinical decision-making, including possible functional consequences of changes seen in the images, contraindications to treatment, and indications for referral. The interviews were transcribed and analyzed in the tradition of grounded theory. This study found that the informants’ evaluation of imaging studies was contextual and non-systematic, guided by the clinical presentation. The informants used imaging studies to provide a deeper understanding of clinical findings and widen perspectives, arriving at clinical decisions through the synthesis of imaging, clinical findings, and didactic knowledge. They tended to look for imaging evidence of interference with normal motion, rather than evidence of pathology. Overall, the informants expressed conservative views on the use of imaging, noting they would rather use clinical findings and treatment response than imaging findings as a basis for referral to other health care professionals. Using imaging studies to support clinical decision-making can provide physical therapists a wider perspective when planning treatment interventions. By showing physical therapists’ approach to interpreting imaging studies and how this relates to their clinical decision-making, the findings of this study could contribute to discussions of the place of imaging in physical therapist practice, as well as help set objectives for imaging curricula in professional-level and continuing education.
8
Wolf, Lisa Adams. "Testing and refinement of an integrated, ethically-driven environmental model of clinical decision-making in emergency settings." Thesis, Boston College, 2011. http://hdl.handle.net/2345/2224.
Full textAbstract:
Thesis advisor: Dorothy A. JonesThesis advisor: Pamela J. Grace
The purpose of the study was to explore the relationship between multiple variables within a model of critical thinking and moral reasoning that support and refine the elements that significantly correlate with accuracy and clinical decision-making. Background: Research to date has identified multiple factors that are integral to clinical decision-making. The interplay among suggested elements within the decision making process particular to the nurse, the patient, and the environment remain unknown. Determining the clinical usefulness and predictive capacity of an integrated ethically driven environmental model of decision making (IEDEM-CD) in emergency settings in facilitating accuracy in problem identification is critical to initial interventions and safe, cost effective, quality patient care outcomes. Extending the literature of accuracy and clinical decision making can inform utilization, determination of staffing ratios, and the development of evidence driven care models. Methodology: The study used a quantitative descriptive correlational design to examine the relationships between multiple variables within the IEDEM-CD model. A purposive sample of emergency nurses was recruited to participate in the study resulting in a sample size of 200, calculated to yield a power of 0.80, significance of .05, and a moderate effect size. The dependent variable, accuracy in clinical decision-making, was measured by scores on clinical vignettes. The independent variables of moral reasoning, perceived environment of care, age, gender, certification in emergency nursing, educational level, and years of experience in emergency nursing, were measures by the Defining Issues Test, version 2, the Revised Professional Practice Environment scale, and a demographic survey. These instruments were identified to test and refine the elements within the IEDEM-CD model. Data collection occurred via internet survey over a one month period. Rest's Defining Issues Test, version 2 (DIT-2), the Revised Professional Practice Environment tool (RPPE), clinical vignettes as well as a demographic survey were made available as an internet survey package using Qualtrics TM. Data from each participant was scored and entered into a PASW database. The analysis plan included bivariate correlation analysis using Pearson's product-moment correlation coefficients followed by chi square and multiple linear regression analysis. Findings: The elements as identified in the IEDEM-CD model supported moral reasoning and environment of care as factors significantly affecting accuracy in decision-making. Findings reported that in complex clinical situations, higher levels of moral reasoning significantly affected accuracy in problem identification. Attributes of the environment of care including teamwork, communication about patients, and control over practice also significantly affected nurses' critical cue recognition and selection of appropriate interventions. Study results supported the conceptualization of the IEDEM-CD model and its usefulness as a framework for predicting clinical decision making accuracy for emergency nurses in practice, with further implications in education, research and policy
Thesis (PhD) — Boston College, 2011
Submitted to: Boston College. Connell School of Nursing
Discipline: Nursing
9
Shaban, Ramon Zenel. "Paramedic Clinical Judgement and Decision-Making of Mental Illness in the Pre-Hospital Emergency Care Setting: A Case Study of Accounts of Practice." Thesis, Griffith University, 2011. http://hdl.handle.net/10072/365994.
Full textAbstract:
The introduction of legislation governing the management of mental illness in Queensland led to complaints from paramedics and their industrial association to the Commissioner of the Queensland Ambulance Service regarding the inadequacy of education and training to fulfil their new practice obligations. The industrial association asserted that their members were ill-prepared, insufficiently skilled, and unsupported professionally to make clinical judgements and decisions about mental illness in the pre-hospital emergency care setting. Furthermore, they raised concerns that their members were at significant risk of harm from patients with mental illness, and that they were vulnerable to litigation for actions of negligence and breaches of duty of care that were a direct result of the inadequacy of their education and training. These concerns, coupled with a lack of published literature that might address them, highlighted the need for a deeper understanding of how paramedics accomplish clinical judgement and decision-making of mental illness in the field, and the factors that influence this aspect of their work. Integral to the concerns were questions about the relationship between the formal expectations of paramedic practice—in the form of legislation and clinical policy—and their actual judgement practice in the field. At issue in this study was the preparedness of paramedics to recognise, assess, and manage mental illness in everyday practice and the sufficiency of education and training programs, clinical standards, policy, and legislation for ensuring quality practice and accountability in the field.
To understand how paramedics accomplish clinical judgement and decision-making of mental illness in the Queensland pre-hospital emergency care setting and the factors that influence this aspect of their work, this thesis adopted a descriptive theoretical framework of judgement and decision-making (Bell, Raiffa, & Tversky, 1988a) and undertook an interpretive, naturalistic case study according to Stake (1995). In this study, the cases were paramedics, the context was the Queensland pre-hospital emergency care setting, and the issue was how they accomplished clinical judgement and decision-making of mental illness. The study of paramedic clinical judgement and decision-making of mental illness was conducted in two iterative and recursive phases.Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Education and Professional Studies
Arts, Education and Law
Full Text
10
Gosnell, Susan. "Teaching and Assessing Critical Thinking in Radiologic Technology Students." Doctoral diss., University of Central Florida, 2010. http://digital.library.ucf.edu/cdm/ref/collection/ETD/id/3594.
Full textAbstract:
The purpose of this study was primarily to explore the conceptualization of critical thinking development in radiologic science students by radiography program directors. Seven research questions framed three overriding themes including 1) perceived definition of and skills associated with critical thinking; 2) effectiveness and utilization of teaching strategies for the development of critical thinking; and 3) appropriateness and utilization of specific assessment measures for documenting critical thinking development. The population for this study included program directors for all JRCERT accredited radiography programs in the United States. Questionnaires were distributed via Survey Monkey©, a commercial on-line survey tool to 620 programs. A forty-seven percent (n = 295) response rate was achieved and included good representation from each of the three recognized program levels (AS, BS and certificate). Statistical analyses performed on the collected data included descriptive analyses (median, mean and standard deviation) to ascertain overall perceptions of the definition of critical thinking; levels of agreement regarding the effectiveness of listed teaching strategies and assessment measures; and the degree of utilization of the same teaching strategies and assessment measures. Chi squared analyses were conducted to identify differences within each of these themes between various program levels and/or between program directors with various levels of educational preparation as defined by the highest degree earned. Results showed that program directors had a broad and somewhat ambiguous perception of the definition of critical thinking, which included many related cognitive processes that were not always classified as attributes of critical thinking according to the literature, but were consistent with definitions and attributes identified as critical thinking by other allied health professions. These common attributes included creative thinking, decision making, problem solving and clinical reasoning as well as other high-order thinking activities such as reflection, judging and reasoning deductively and inductively. Statistically significant differences were identified for some items based on program level and for one item based on program director highest degree. There was general agreement regarding the appropriateness of specific teaching strategies also supported by the literature with the exception of on-line discussions and portfolios. The most highly used teaching strategies reported were not completely congruent with the literature and included traditional lectures with in-class discussions and high-order multiple choice test items. Significant differences between program levels were identified for only two items. The most highly used assessment measures included clinical competency results, employer surveys, image critique performance, specific course assignments, student surveys and ARRT exam results. Only one variable showed significant differences between programs at various academic levels.Ed.D.
Department of Educational and Human Sciences
Education
Education EdD
Books on the topic "Clinical decision making;reasoning;judgement"
1
C, Turk Dennis, and Salovey Peter, eds. Reasoning, inference, and judgment in clinical psychology. New York: Free Press, 1988.
Find full text
2
B, Wong John, and Kopelman Richard I, eds. Learning clinical reasoning. 2nd ed. Philadelphia: Wolters Kluwer Lippincott Williams & Wilkins Health, 2010.
Find full text
3
I, Kopelman Richard, ed. Learning clinical reasoning. Baltimore: Williams & Wilkins, 1991.
Find full text
4
1939-, Munson Ronald, and Resnik Michael D, eds. Reasoning in medicine: An introduction to clinical inference. Baltimore: Johns Hopkins University Press, 1988.
Find full text
5
Montgomery, Kathryn. How doctors think: Clinical judgement and the practice of medicine. New York, NY: Oxford University Press, 2005.
Find full text
6
Montgomery, Kathryn. How doctors think: Clinical judgement and the practice of medicine. New York: Oxford University Press, 2005.
Find full text
7
Richard, Paul, and Elder Linda, eds. The thinker's guide to clinical reasoning. Dillon, California: Foundation for Critical Thinking, 2010.
Find full text
8
Benamy, Barbara Cortellini. Developing clinical reasoning skills: Strategies for the occupational therapist. San Antonio: Therapy Skill Builders, 1996.
Find full text
9
Benamy, Barbara Cortellini. Developing clinical reasoning skills: Strategies for the occupational therapist. San Antonio: Therapy Skill Builders, 1996.
Find full text
10
Critical thinking, clinical reasoning, and clinical judgment: A practical approach. 5th ed. St. Louis, MO: Saunders/Elsevier, 2013.
Find full textBook chapters on the topic "Clinical decision making;reasoning;judgement"
1
Degoulet, Patrice, and Marius Fieschi. "Medical Reasoning and Decision-Making." In Introduction to Clinical Informatics, 49–64. New York, NY: Springer New York, 1997. http://dx.doi.org/10.1007/978-1-4612-0675-0_4.
Full text
2
Owens, Douglas K., and Harold C. Sox. "Biomedical Decision Making: Probabilistic Clinical Reasoning." In Biomedical Informatics, 67–107. London: Springer London, 2013. http://dx.doi.org/10.1007/978-1-4471-4474-8_3.
Full text
3
Owens, Douglas K., and Harold C. Sox. "Biomedical Decision Making: Probabilistic Clinical Reasoning." In Health Informatics, 80–132. New York, NY: Springer New York, 2006. http://dx.doi.org/10.1007/0-387-36278-9_3.
Full text
4
Owens, Douglas K., Jeremy D. Goldhaber-Fiebert, and Harold C. Sox. "Biomedical Decision Making: Probabilistic Clinical Reasoning." In Biomedical Informatics, 77–120. Cham: Springer International Publishing, 2021. http://dx.doi.org/10.1007/978-3-030-58721-5_3.
Full text
5
Sheppard, Michael. "Judgement and decision making: practical reasoning, process knowledge and critical thinking." In Social Work and Social Exclusion, 197–217. London: Routledge, 2021. http://dx.doi.org/10.4324/9781315242859-12.
Full text
6
Li, Qingshan, Jing Feng, Lu Wang, Hua Chu, and WeiJuan Fu. "Knowledge Reasoning Model to Support Clinical Decision Making." In Information Technology in Bio- and Medical Informatics, 75–78. Cham: Springer International Publishing, 2014. http://dx.doi.org/10.1007/978-3-319-10265-8_6.
Full text
7
Fuentes Herrera, Ivett E., Beatriz Valdés Pérez, María M. García Lorenzo, Leticia Arco García, Mabel M. Herrera González, and Rolando de la C. Fuentes Morales. "A Case-Based Reasoning Framework for Clinical Decision Making." In Advances in Soft Computing, 290–301. Cham: Springer International Publishing, 2018. http://dx.doi.org/10.1007/978-3-030-02837-4_24.
Full text
8
Noll, Richard, Jannik Schaaf, and Holger Storf. "The Use of Computer-Assisted Case-Based Reasoning to Support Clinical Decision-Making – A Scoping Review." In Case-Based Reasoning Research and Development, 395–409. Cham: Springer International Publishing, 2022. http://dx.doi.org/10.1007/978-3-031-14923-8_26.
Full text
9
Banzi, Annalisa. "Problem Solving, Decision-Making, Judgement, Reasoning, and Creativity: The Role of Museums in the Visitors' Cognitive Growth." In The Brain-Friendly Museum, 68–82. London: Routledge, 2022. http://dx.doi.org/10.4324/9781003304531-6.
Full text
10
Koivisto, Jaana-Maija, Sara Havola, Henna Mäkinen, and Elina Haavisto. "Learning Clinical Reasoning Through Gaming in Nursing Education: Future Scenarios of Game Metrics and Artificial Intelligence." In AI in Learning: Designing the Future, 159–73. Cham: Springer International Publishing, 2022. http://dx.doi.org/10.1007/978-3-031-09687-7_10.
Full textAbstract:
AbstractThe COVID-19 pandemic has challenged healthcare professionals’ clinical reasoning, which can have serious consequences for patients. So far, the use of artificial intelligence (AI) in nursing education has been limited. Artificial intelligence (AI) is one solution for ensuring quality decision-making in demanding clinical situations in two ways. First, AI applications can support healthcare professionals’ clinical decisions. Second, AI techniques can be used to support learning clinical reasoning (CR) in healthcare education and training. This chapter focuses on the potential of exploiting AI through game metrics in nursing education. Previously, simulation games have proven effective for learning clinical reasoning skills. However, game metrics have not been commonly utilized in nursing simulation games, although research in other disciplines has shown that game metrics are suitable for demonstrating the achievement of learning outcomes. This chapter discusses the possibilities of using game metrics to develop adaptive features for nursing simulation games. Personalization and adaptivity in simulation games can enable meaningful learning experiences and enable nursing students to achieve good CR skills for their future work in constantly challenging clinical situations.
Conference papers on the topic "Clinical decision making;reasoning;judgement"
1
Narasimhan, Lakshmi, Di Wu, and Narinder Gill. "Meta-Analysis of Clinical Cardiovascular Data towards Evidential Reasoning for Cardiovascular Life Cycle Management." In InSITE 2007: Informing Science + IT Education Conference. Informing Science Institute, 2007. http://dx.doi.org/10.28945/3147.
Full textAbstract:
The cardiovascular disease is one of the serious and life-threatening diseases in the developed world. One aspect of medical treatment is using drugs with blood pressure reducing or cholesterol lowering functions. Importantly, such treatment needs to be individually tailored and is significantly correlated to the particular conditions of individual patients. However, such pathologies and mechanisms are still only under investigation. Several novel and unique computational methods, called meta-analyses techniques, for formatting and analyzing a wide variety of cardiac datasets are discussed in this paper with the aim to building cardiovascular database and related patient life-cycle management services. In this paper we also present an overview of a second order inference engine underlying the meta-analyses, which yields evidenced-based reasoning that is more likely to better assist decision-making on the effectiveness of cardiovascular treatment than what is available currently. Furthermore, the software architecture and other details of such a medical informatics system tailored to cardiovascular disease are also described. Research and development work on this project yields itself to application to many other areas, such as disease control and prevention in Epidemiology, and dietics. The system can therefore make a profound impact to medical informatics.
2
Molinet, Benjamin, Santiago Marro, Elena Cabrio, Serena Villata, and Tobias Mayer. "ACTA 2.0: A Modular Architecture for Multi-Layer Argumentative Analysis of Clinical Trials." In Thirty-First International Joint Conference on Artificial Intelligence {IJCAI-22}. California: International Joint Conferences on Artificial Intelligence Organization, 2022. http://dx.doi.org/10.24963/ijcai.2022/859.
Full textAbstract:
Evidence-based medicine aims at making decisions about the care of individual patients based on the explicit use of the best available evidence in the patient clinical history and the medical literature results. Argumentation represents a natural way of addressing this task by (i) identifying evidence and claims in text, and (ii) reasoning upon the extracted arguments and their relations to make a decision. ACTA 2.0 is an automated tool which relies on Argument Mining methods to analyse the abstracts of clinical trials to extract argument components and relations to support evidence-based clinical decision making. ACTA 2.0 allows also for the identification of PICO (Patient, Intervention, Comparison, Outcome) elements, and the analysis of the effects of an intervention on the outcomes of the study. A REST API is also provided to exploit the tool’s functionalities.
Reports on the topic "Clinical decision making;reasoning;judgement"
1
Zachry, Anne, J. Flick, and S. Lancaster. Tune Up Your Teaching Toolbox! University of Tennessee Health Science Center, 2016. http://dx.doi.org/10.21007/chp.ot.fp.2016.0001.
Full textAbstract:
Occupational therapy (OT) educators strive to prepare entry-level practitioners who have the expertise to meet the diverse health care needs of society. A variety of instructional methods are used in the University of Tennessee Health Science Center (UTHSC) MOT program, including traditional lecture-based instruction (LBI), problem-based learning (PBL), team-based learning (TBL), and game-based learning (GBL). Research suggests that active learning strategies develop the critical thinking and problem-solving skills that are necessary for effective clinical reasoning and decision-making abilities. PBL, TBL, GBL are being successfully implemented in the UTHSC MOT Program to enhance the learning process and improve student engagement.
2
Newman-Toker, David E., Susan M. Peterson, Shervin Badihian, Ahmed Hassoon, Najlla Nassery, Donna Parizadeh, Lisa M. Wilson, et al. Diagnostic Errors in the Emergency Department: A Systematic Review. Agency for Healthcare Research and Quality (AHRQ), December 2022. http://dx.doi.org/10.23970/ahrqepccer258.
Full textAbstract:
Objectives. Diagnostic errors are a known patient safety concern across all clinical settings, including the emergency department (ED). We conducted a systematic review to determine the most frequent diseases and clinical presentations associated with diagnostic errors (and resulting harms) in the ED, measure error and harm frequency, as well as assess causal factors. Methods. We searched PubMed®, Cumulative Index to Nursing and Allied Health Literature (CINAHL®), and Embase® from January 2000 through September 2021. We included research studies and targeted grey literature reporting diagnostic errors or misdiagnosis-related harms in EDs in the United States or other developed countries with ED care deemed comparable by a technical expert panel. We applied standard definitions for diagnostic errors, misdiagnosis-related harms (adverse events), and serious harms (permanent disability or death). Preventability was determined by original study authors or differences in harms across groups. Two reviewers independently screened search results for eligibility; serially extracted data regarding common diseases, error/harm rates, and causes/risk factors; and independently assessed risk of bias of included studies. We synthesized results for each question and extrapolated U.S. estimates. We present 95 percent confidence intervals (CIs) or plausible range (PR) bounds, as appropriate. Results. We identified 19,127 citations and included 279 studies. The top 15 clinical conditions associated with serious misdiagnosis-related harms (accounting for 68% [95% CI 66 to 71] of serious harms) were (1) stroke, (2) myocardial infarction, (3) aortic aneurysm and dissection, (4) spinal cord compression and injury, (5) venous thromboembolism, (6/7 – tie) meningitis and encephalitis, (6/7 – tie) sepsis, (8) lung cancer, (9) traumatic brain injury and traumatic intracranial hemorrhage, (10) arterial thromboembolism, (11) spinal and intracranial abscess, (12) cardiac arrhythmia, (13) pneumonia, (14) gastrointestinal perforation and rupture, and (15) intestinal obstruction. Average disease-specific error rates ranged from 1.5 percent (myocardial infarction) to 56 percent (spinal abscess), with additional variation by clinical presentation (e.g., missed stroke average 17%, but 4% for weakness and 40% for dizziness/vertigo). There was also wide, superimposed variation by hospital (e.g., missed myocardial infarction 0% to 29% across hospitals within a single study). An estimated 5.7 percent (95% CI 4.4 to 7.1) of all ED visits had at least one diagnostic error. Estimated preventable adverse event rates were as follows: any harm severity (2.0%, 95% CI 1.0 to 3.6), any serious harms (0.3%, PR 0.1 to 0.7), and deaths (0.2%, PR 0.1 to 0.4). While most disease-specific error rates derived from mainly U.S.-based studies, overall error and harm rates were derived from three prospective studies conducted outside the United States (in Canada, Spain, and Switzerland, with combined n=1,758). If overall rates are generalizable to all U.S. ED visits (130 million, 95% CI 116 to 144), this would translate to 7.4 million (PR 5.1 to 10.2) ED diagnostic errors annually; 2.6 million (PR 1.1 to 5.2) diagnostic adverse events with preventable harms; and 371,000 (PR 142,000 to 909,000) serious misdiagnosis-related harms, including more than 100,000 permanent, high-severity disabilities and 250,000 deaths. Although errors were often multifactorial, 89 percent (95% CI 88 to 90) of diagnostic error malpractice claims involved failures of clinical decision-making or judgment, regardless of the underlying disease present. Key process failures were errors in diagnostic assessment, test ordering, and test interpretation. Most often these were attributed to inadequate knowledge, skills, or reasoning, particularly in “atypical” or otherwise subtle case presentations. Limitations included use of malpractice claims and incident reports for distribution of diseases leading to serious harms, reliance on a small number of non-U.S. studies for overall (disease-agnostic) diagnostic error and harm rates, and methodologic variability across studies in measuring disease-specific rates, determining preventability, and assessing causal factors. Conclusions. Although estimated ED error rates are low (and comparable to those found in other clinical settings), the number of patients potentially impacted is large. Not all diagnostic errors or harms are preventable, but wide variability in diagnostic error rates across diseases, symptoms, and hospitals suggests improvement is possible. With 130 million U.S. ED visits, estimated rates for diagnostic error (5.7%), misdiagnosis-related harms (2.0%), and serious misdiagnosis-related harms (0.3%) could translate to more than 7 million errors, 2.5 million harms, and 350,000 patients suffering potentially preventable permanent disability or death. Over two-thirds of serious harms are attributable to just 15 diseases and linked to cognitive errors, particularly in cases with “atypical” manifestations. Scalable solutions to enhance bedside diagnostic processes are needed, and these should target the most commonly misdiagnosed clinical presentations of key diseases causing serious harms. New studies should confirm overall rates are representative of current U.S.-based ED practice and focus on identified evidence gaps (errors among common diseases with lower-severity harms, pediatric ED errors and harms, dynamic systems factors such as overcrowding, and false positives). Policy changes to consider based on this review include: (1) standardizing measurement and research results reporting to maximize comparability of measures of diagnostic error and misdiagnosis-related harms; (2) creating a National Diagnostic Performance Dashboard to track performance; and (3) using multiple policy levers (e.g., research funding, public accountability, payment reforms) to facilitate the rapid development and deployment of solutions to address this critically important patient safety concern.