Evidence-Based Decision Support for Neurological Diagnosis Reduces Errors and Unnecessary Workup

Author:

Segal Michael M.1,Williams Marc S.2,Gropman Andrea L.3,Torres Alcy R.4,Forsyth Rob5,Connolly Anne M.6,El-Hattab Ayman W.7,Perlman Seth J.6,Samanta Debopam8,Parikh Sumit9,Pavlakis Steven G.10,Feldman Lynn K.1,Betensky Rebecca A.11,Gospe Sidney M.12

Affiliation:

1. SimulConsult, Chestnut Hill, MA, USA

2. Genomic Medicine Institute, Geisinger Health System, Danville, PA, USA

3. Neurogenetics Program, Children’s National Medical Center, Washington, DC, USA

4. Department of Neurology, Children’s Hospital, Boston, MA, USA

5. Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK

6. Departments of Neurology and Pediatrics, Washington University, St Louis, MO, USA

7. Medical Genetics Section, Department of Pediatrics, The Children’s Hospital, King Fahad Medical City and Faculty of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia

8. Department of Pediatrics, University of Virginia, Charlottesville, VA, USA

9. Neurogenetics & Neurometabolism Program, Neurologic Institute, Cleveland Clinic, Cleveland, OH, USA

10. Center for Brain and Behavior, Maimonides Medical Center, Brooklyn, NY, USA

11. Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA

12. Departments of Neurology and Pediatrics, University of Washington, Seattle, WA, USA

Abstract

Using vignettes of real cases and the SimulConsult diagnostic decision support software, neurologists listed a differential diagnosis and workup before and after using the decision support. Using the software, there was a significant reduction in error, up to 75% for diagnosis and 56% for workup. This error reduction occurred despite the baseline being one in which testers were allowed to use narrative resources and Web searching. A key factor that improved performance was taking enough time (>2 minutes) to enter clinical findings into the software accurately. Under these conditions and for instances in which the diagnoses changed based on using the software, diagnostic accuracy improved in 96% of instances. There was a 6% decrease in the number of workup items accompanied by a 34% increase in relevance. The authors conclude that decision support for a neurological diagnosis can reduce errors and save on unnecessary testing.

Publisher

SAGE Publications

Subject

Neurology (clinical),Pediatrics, Perinatology and Child Health

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