User login
We thank Dr. Santhosh and colleagues for their letter concerning our article.1 We agree that the diagnostic journey includes interactions both between and across teams, not just those within the patient’s team. In an article currently in press in Diagnosis, we examine how systems and cognitive factors interact during the process of diagnosis. Specifically, we reported on how communication between consultants can be both a barrier and facilitator to the diagnostic process.2 We found that the frequency, quality, and pace of communication between and across inpatient teams and specialists are essential to timely diagnoses. As diagnostic errors remain a costly and morbid issue in the hospital setting, efforts to improve communication are clearly needed.3
Santhosh et al. raise an interesting point regarding cognitive load in evaluating diagnosis. Cognitive load is a multidimensional construct that represents the load that performing a specific task poses on a learner’s cognitive system.4 Components often used for measuring load include (a) task characteristics such as format, complexity, and time pressure; (b) subject characteristics such as expertise level, age, and spatial abilities; and (c) mental load and effort that originate from the interaction between task and subject characteristics.5 While there is little doubt that measuring these constructs has face value in diagnosis, we know of no instruments that are nimble
Disclosures
The authors have nothing to disclose.
Funding
This project was supported by grant number P30HS024385 from the Agency for Healthcare Research and Quality. The funding source played no role in study design, data acquisition, analysis or decision to report these data.
1. Chopra V, Harrod M, Winter S, et al. Focused ethnography of diagnosis in academic medical centers. J Hosp Med. 2018;13(10):668-672. doi: 10.12788/jhm.2966 PubMed
2. Gupta A, Harrod M, Quinn M, et al. Mind the overlap: how system problems contribute to cognitive failure and diagnostic errors. Diagnosis. 2018; In Press PubMed
3. Gupta A, Snyder A, Kachalia A, et al. Malpractice claims related to diagnostic errors in the hospital [published online ahead of print August 11, 2017]. BMJ Qual Saf. 2017. doi: 10.1136/bmjqs-2017-006774 PubMed
4. Paas FG, Van Merrienboer JJ, Adam JJ. Measurement of cognitive load in instructional research. Percept Mot Skills. 1994;79(1 Pt 2):419-30. doi: 10.2466/pms.1994.79.1.419 PubMed
5. Paas FG, Tuovinen JE, Tabbers H, et al. Cognitive load measurement as a means to advance cognitive load theory. Educational Psychologist. 2003;38(1):63-71. doi: 10.1207/S15326985EP3801_8
We thank Dr. Santhosh and colleagues for their letter concerning our article.1 We agree that the diagnostic journey includes interactions both between and across teams, not just those within the patient’s team. In an article currently in press in Diagnosis, we examine how systems and cognitive factors interact during the process of diagnosis. Specifically, we reported on how communication between consultants can be both a barrier and facilitator to the diagnostic process.2 We found that the frequency, quality, and pace of communication between and across inpatient teams and specialists are essential to timely diagnoses. As diagnostic errors remain a costly and morbid issue in the hospital setting, efforts to improve communication are clearly needed.3
Santhosh et al. raise an interesting point regarding cognitive load in evaluating diagnosis. Cognitive load is a multidimensional construct that represents the load that performing a specific task poses on a learner’s cognitive system.4 Components often used for measuring load include (a) task characteristics such as format, complexity, and time pressure; (b) subject characteristics such as expertise level, age, and spatial abilities; and (c) mental load and effort that originate from the interaction between task and subject characteristics.5 While there is little doubt that measuring these constructs has face value in diagnosis, we know of no instruments that are nimble
Disclosures
The authors have nothing to disclose.
Funding
This project was supported by grant number P30HS024385 from the Agency for Healthcare Research and Quality. The funding source played no role in study design, data acquisition, analysis or decision to report these data.
We thank Dr. Santhosh and colleagues for their letter concerning our article.1 We agree that the diagnostic journey includes interactions both between and across teams, not just those within the patient’s team. In an article currently in press in Diagnosis, we examine how systems and cognitive factors interact during the process of diagnosis. Specifically, we reported on how communication between consultants can be both a barrier and facilitator to the diagnostic process.2 We found that the frequency, quality, and pace of communication between and across inpatient teams and specialists are essential to timely diagnoses. As diagnostic errors remain a costly and morbid issue in the hospital setting, efforts to improve communication are clearly needed.3
Santhosh et al. raise an interesting point regarding cognitive load in evaluating diagnosis. Cognitive load is a multidimensional construct that represents the load that performing a specific task poses on a learner’s cognitive system.4 Components often used for measuring load include (a) task characteristics such as format, complexity, and time pressure; (b) subject characteristics such as expertise level, age, and spatial abilities; and (c) mental load and effort that originate from the interaction between task and subject characteristics.5 While there is little doubt that measuring these constructs has face value in diagnosis, we know of no instruments that are nimble
Disclosures
The authors have nothing to disclose.
Funding
This project was supported by grant number P30HS024385 from the Agency for Healthcare Research and Quality. The funding source played no role in study design, data acquisition, analysis or decision to report these data.
1. Chopra V, Harrod M, Winter S, et al. Focused ethnography of diagnosis in academic medical centers. J Hosp Med. 2018;13(10):668-672. doi: 10.12788/jhm.2966 PubMed
2. Gupta A, Harrod M, Quinn M, et al. Mind the overlap: how system problems contribute to cognitive failure and diagnostic errors. Diagnosis. 2018; In Press PubMed
3. Gupta A, Snyder A, Kachalia A, et al. Malpractice claims related to diagnostic errors in the hospital [published online ahead of print August 11, 2017]. BMJ Qual Saf. 2017. doi: 10.1136/bmjqs-2017-006774 PubMed
4. Paas FG, Van Merrienboer JJ, Adam JJ. Measurement of cognitive load in instructional research. Percept Mot Skills. 1994;79(1 Pt 2):419-30. doi: 10.2466/pms.1994.79.1.419 PubMed
5. Paas FG, Tuovinen JE, Tabbers H, et al. Cognitive load measurement as a means to advance cognitive load theory. Educational Psychologist. 2003;38(1):63-71. doi: 10.1207/S15326985EP3801_8
1. Chopra V, Harrod M, Winter S, et al. Focused ethnography of diagnosis in academic medical centers. J Hosp Med. 2018;13(10):668-672. doi: 10.12788/jhm.2966 PubMed
2. Gupta A, Harrod M, Quinn M, et al. Mind the overlap: how system problems contribute to cognitive failure and diagnostic errors. Diagnosis. 2018; In Press PubMed
3. Gupta A, Snyder A, Kachalia A, et al. Malpractice claims related to diagnostic errors in the hospital [published online ahead of print August 11, 2017]. BMJ Qual Saf. 2017. doi: 10.1136/bmjqs-2017-006774 PubMed
4. Paas FG, Van Merrienboer JJ, Adam JJ. Measurement of cognitive load in instructional research. Percept Mot Skills. 1994;79(1 Pt 2):419-30. doi: 10.2466/pms.1994.79.1.419 PubMed
5. Paas FG, Tuovinen JE, Tabbers H, et al. Cognitive load measurement as a means to advance cognitive load theory. Educational Psychologist. 2003;38(1):63-71. doi: 10.1207/S15326985EP3801_8
© 2018 Society of Hospital Medicine