Checklists and Tools for Diagnosis

Checklists exist in every industry and setting, whenever a critical process needs to be completed without introducing errors.(1) Similarly, checklists in medicine, as exemplified by surgical checklists, and checklists for central line insertion, have improved the quality and safety of medical care.(2-4)

Many different checklists have been proposed to improve diagnosis in medicine. Additional research will be needed to validate the impact of these lists on the likelihood of diagnostic errors; they may be helpful in addressing the most common cognitive causes for missing the correct diagnosis, including #1 on that list: “I just didn’t consider it.” (5)

Please contact SIDM at info@improvediagnosis.org if you have comments on these resources or to add additional checklists as they become available. The checklists are provided for educational purposes only and should not be construed as medical advice. Publication does not indicate SIDM endorsement.

 

 John Ely's checklists for DIFFERENTIAL DIAGNOSIS

Get them for your smart phone !

On your phone, navigate to http://pie.med.utoronto.ca/DC/

Select "mobile version"

When the checklists appear, there will be an option at the bottom of the screen to add this site to your phone's desktop. This will create a new icon that takes you to the lists directly.

 


Two types of checklists have been developed:

Process Checklists

These address common cognitive shortcomings that contribute to diagnostic error, as noted in prior research studies

  A General Checklist
 Mark L Graber et al (6)
 A Process Checklist
 William Follansbee et al- University of Pittsburgh
 A General Checklist
 Timothy Krohe
 Ten Commandments to Reduce Cognitive Errors
 Leo Leonidas
 The SAFER Checklist
 Robert Trowbridge
 The THINK Checklist
 Lara Kothari
  VITAMIN CC&D  Attribution unknown
  TAKE 2 – Think, DO
 Clinical Excellence Commission
  Red Team – Blue Team
 Clinical Excellence Commission
  Red Team- Blue Team  New South Wales Australia
 

Amanda Walker, Clinical Director;Tracy Clark,Project Lead

 

Content Checklists:

These help bring to mind the most common diagnoses for any given symptom. The set of specific checklists developed by Dr John Ely were based on symptoms commonly seen in the practice of family medicine.(7)

Symptom-Specific Diagnostic Checklists– John Ely

 

Mark L Graber, MD
President, Society to Improve Diagnosis in Medicine
Senior Fellow, RTI International
Professor Emeritus, SUNY Stony Brook, NY

John W. Ely, MD, MSPH
Professor Emeritus, University of Iowa Carver College of Medicine

Robert Trowbridge MD, Maine Medical Center

William P Follansbee, MD
Director, University of Pittsburgh Clinical Center for Medical Decision Making

Timothy Krohe, MD
Department of Veterans Affairs Medical Center

Lara Kothari, MD
Associate Program Director
Children’s Hospital of Michigan

Leonardo L. Leonidas, MD
Assistant Clinical Professor in Pediatrics (retired 2008)
Distinguished Career Teaching Award, 2009
Tufts University School of Medicine, Boston, USA

Clinical Excellence Commission
Prof. Amanda Walker – Clinical Director
Tracy Clarke – Project Lead, Diagnostic Error
CEC-Take2@health.nsw.gov.au

 

 References:

  1. Gawande A. The Checklist Manifesto - How to Get Things Right. New York, NY: Metropolitan Books; Henry Holt and Company, LLC; 2009.
  2. Pronovost P, Needham D, Berenholz S, Sinopoli D, Chu H, Cosgrove S, et al.- An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med. 2006;355:2725-32.
  3. Boat AC, Spaeth JP. Handoff -checklists improve the reliability of patient handoffs in the operating room and postanesthesia care unit. Paediatr Anaesth. 2013;23:647-54.
  4. Haynes AB, Weiser TG, Berry WR, Lipsitz SR, Breizat AHS, et al.- A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med. 2010;360:491-9.
  5. Bordage G.- Why did I miss the diagnosis? Some cognitive explanations and educational implications. Acad Med. 1999;74(10 Suppl):S138-43.
  6. Graber M, Sorensen A, Biswas J, Modi V, Wackett A, Johnson S, et al.- Developing checklists to prevent diagnostic error in Emergency Room settings. Diagnosis. 2014;1(3):223-31.
  7. Ely JW, Graber ML, Croskerry P.- Checklists to reduce diagnostic errors. Academic Medicine. 2011;Mar;86(3):307-13.