"Physical therapy is not a subspecialty of the medical profession and physical therapists are not medical doctors; we are a separate profession that provides a unique service that physicians are unable and untrained to provide."

Letter to the AMA from the APTA, Dec 2009

Saturday, January 28, 2012

New Decision Support Tool Prevents Diagnostic Errors

Physical therapists practicing in a direct access setting of performing diagnostic work may find these new tools helpful to maintain a low rate of missed diagnoses.

Isabel Healthcare of Ann Arbor, Michigan and the British Medical Journal (BMJ) of London, England came together to create a new diagnostic decision support tool to help doctors diagnose rare diseases that may be overlooked in the busy clinical environment.

The doctor enters key patient findings into the computer or handheld device and the computer returns a list of potential diagnoses with high-risk "Don't Miss" diagnoses flagged.

A 2009 report titled Diagnostic Error in Medicine: Analysis of 583 Physician-Reported Errors revealed the top misdiagnoses in medicine. Of 669 cases, the following misdiagnoses were reported:
DiseaseNumber of casesIncidence
Pulmonary embolism26 cases4.5% of total
Drug reactions or overdose 26 cases 4.5%
Lung cancer 23 cases 3.9%
Colorectal cancer 19 cases 3.3%
Acute coronary syndrome 18 cases 3.1%
Breast cancer 18 cases 3.1%
Stroke 15 cases 2.6%

Isabel is a 10-year old clinical decision support tool that has been validated in the peer reviewed literature and is endorsed by the American Medical Association (AMA)

BMJ Best Practice is a point-of-care decision support tool that provides the latest evidence-based medical information from the BMJ Evidence Centre.

Prevention of diagnostic errors can lead to improved accuracy and time of diagnosis and better treatments for patients.

Timing of Diagnostic Errors
Testing phase: failure to order, report, and follow-up laboratory results 44%
Clinician assessment errors: failure to consider and overweighing competing diagnosis32%
History taking10%
Physical examination10%
Referral or consultation errors and delays3%

This new tool may be of interest to physical therapists who practice in a direct access or primary care setting.

Increasingly, physical therapists are being asked to perform diagnostic decision making in direct access or primary care settings.

The use of new tools and new technologies should help physical therapists maintain a low rate of misdiagnoses.

Free Tutorial

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Tim Richardson, PT owns a private practice at Medical Arts Rehabilitation, Inc in Palmetto, Florida. The clinic website is at MedicalArtsRehab.com.

Bulletproof Expert Systems: Clinical Decision Support for Physical Therapists in the Outpatient Setting is a manager's workbook with stories, checklists, charts, graphs, tables, and templates describing how you can use paper-based or computerized tools to improve your clinic's Medicare compliance, process adherence and patient outcomes.

Tim has implemented a computerized Clinical Decision Support (CDS) system in his clinic since 2006 that serves as a Reminder, Alerting, Prompting and Predicting CDS using evidence-based tests and measures.

Tim can be reached at
TimRichPT@BulletproofPT.com .

"Make Decisions like Doctors"

Copyright 2007-2010 by Tim Richardson, PT.
No reproduction without authorization.

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