The role of teamwork in diagnosis: team diagnostic decision-making in the medical intensive care unit

Healthcare workers, such as physicians, strive to do no harm; however, preventable medical errors can occur when physician decision-making fails while diagnosing patients. Diagnostic errors, in the form of missed diagnosis, or incorrectly derived diagnosis may result in patient harm or even in death. To study how diagnostic errors occur, and how they may be prevented, researchers primarily have studied the decision-making of individual physicians in order to understand how diagnostic decision-making may fail. Several error reduction methods have been derived, however, it remains unknown how effectively to reduce diagnostic error occurrence. Further, diagnosticians do not work alone to diagnose patients: they work with other providers as a team, and such teamwork neither has been studied regarding diagnostic decision-making, nor diagnostic error. This study, therefore, seeks to understand how healthcare providers work together as a team in order to diagnose a patient. In this study, medical intensive care unit providers are interviewed regarding whom they worked with, whom they perceived as a part of the diagnostic team, when they worked with others, and how varying patient presentations changed their teamwork. Provider perceptions were determined through these interviews, and used to describe how diagnostic teams are structured and how they function. Results are presented and suggestions are made for discussion topics of diagnostic contributions from roles such as nurses and patients. Finally, in this study, are proposed new research questions and methods to assist future studies that examine new sources of diagnostic error, and considerations of error reduction methods are offered.