Situational factors like staffing shortages and workarounds are prevalent. Clinicians in certain areas also experience high levels of stress, fatigue, and burnout. Decision making in a busy, chaotic, and time-pressured healthcare system with a disrupted or newly designed healthcare process is meant to be error-prone
FREMONT, CA: The healthcare industry has always been under pressure as it involves dealing with lives. The outbreak of the COVID-19 pandemic has increased this pressure significantly. The need for timely and accurate diagnosis supersedes every other need on the planet. Diagnostic errors have been a problem with the healthcare industry before the pandemic and have been a major contributing factor to healthcare harm. COVID-19 only increases the chances of such errors. The disease is relatively new, and there is very little information available on it. The clinical manifestations for this disease are still evolving, and both the physical and psychological safety of clinicians and health systems has been compromised. All these factors together can have a significant impact on clinical decision making.
Situational factors like staffing shortages and workarounds are prevalent. Clinicians in certain areas also experience high levels of stress, fatigue, and burnout. Decision making in a busy, chaotic, and time-pressured healthcare systems with a disrupted or newly designed healthcare process is meant to be error-prone. There are different types of diagnostic errors, and these errors span the entire continuum of care and have both system-based and cognitive origins. The outbreak of the pandemic has also lead to many new types of error being discovered.
Classic Error
The classic representation of the COVID-19 pandemic is a respiratory illness that warrants confirmatory testing. However, there may be a lack of a clear test, or the test in use can produce a false negative result. This is referred to as a classic error. Efforts to develop and implement testing protocols are still evolving. There is a lot of local and regional variation in the type and availability of tests. Also, there is significant variation accessibility of information regarding test performance characteristics and diagnostic yield. False-negative test results and unperformed tests can lead to the delayed diagnosis of the disease and increased spread.
Anomalous Error
Testing becomes more relevant when patients present unusual or non-respiratory symptoms. The pattern of symptoms for the virus continues to change dynamically. Both olfactory and gastrointestinal manifestations are now emerging symptoms, along with mysterious new associations like multisystem inflammatory syndromes. The failure to recognize atypical representations and associations can either be due to problems in testing or knowledge gaps. This could lead to overlooking the underlying COVID-19 diagnosis. This type of error is known as anomalous error.
Anchor Error
Mislabeling patients has emerged as a new trend during the pandemic. Patients who do not have the disease are being labeled as COVID-19 positive due to their respiratory symptoms. This is mainly due to the lack of testing in an overwhelming healthcare system with limited capacity to test or treat. This type of error is known as anchor error, and it increases the risk of missing other respiratory infections like bacterial sinusitis and pneumonia, as well as non-respiratory conditions.
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