Patient Safety in Psychiatry-2.4 Diagnostic Errors in Psychiatry

Video Transcription

Part four includes diagnostic errors in psychiatry. Diagnostic errors lead to the highest level of mortality.  Misdiagnosis may be unintentional, but it is an error, and the patient safety approach can be useful to thinking about how to improve that error.  Some examples of misdiagnoses that pose a high risk of associated adverse outcomes include missing delirium, missing withdrawal from alcohol or a set of hypnotics, missing depressed  mood, a CNS mass lesion, or the effects of medications. Misdiagnosis may be partially due to patients and the information gathered from patients,  and it may also be important to remember that physicians play a role in misdiagnosis as well.  There may not yet be basic methods to prevent misdiagnosis, although it is helpful, again, to recognize that misdiagnosis is an error.  And so some basic methods that can be useful include always checking for all medical reasons  for a change in mental status before assigning a psychiatric diagnosis, communicating with all staff members responsible for the patient's care and updating them frequently, working  collaboratively with medical staff and avoiding turf battles, reviewing prior history and complications, asking for help when needed from those who have more experience.  The willingness to do so is a sign of a reduction in the authority gradient and is a good practice to help patient care.  Identifying a main care provider who knows all the facts of a case and interviewing outside informants who know the patient well are other methods to prevent misdiagnosis as an  error in patient care.

Video Summary

In part four of the video, the focus is on diagnostic errors in psychiatry, which have the highest mortality rates. Misdiagnoses, although unintentional, are considered errors and can be improved through a patient safety approach. Specific examples of high-risk misdiagnoses include overlooking delirium, alcohol or hypnotic withdrawal, depressed mood, CNS mass lesions, or medication effects. Patients and gathered information can contribute to misdiagnosis, and physicians also play a role. While there aren't foolproof methods to prevent misdiagnosis, some useful approaches include checking for medical reasons before assigning a psychiatric diagnosis, communicating with all staff members involved in the patient's care, collaborating with medical staff, reviewing history and complications, seeking help from experienced individuals, having a main care provider with comprehensive knowledge, and interviewing outside informants familiar with the patient.

Keywords

diagnostic errors

psychiatry

mortality rates

misdiagnoses

patient safety approach