Development of guidelines to reduce diagnostic errors in psychiatric diagnosis

Abstract

Objective: To develop and assess the content validity of guidelines for reducing diagnostic errors in psychiatric diagnosis.

Methods: Research and development were conducted from September 2023 to June 2024, following the technology development framework. This included surveying the rates, types, and causes of diagnostic errors by retrospectively reviewing psychiatric patient medical records, literature review to establish a conceptual framework, drafting the practice guidelines, and content validity assessment by a panel of five experts using the index of item-objective congruence (IOC). Data were analyzed using descriptive statistics, including frequency and percentage.

Results: Diagnostic errors were found in 56 of 884 inpatients (6.3%). Among these, 39 cases (69.6%) were classified as wrong diagnoses, while 17 cases (30.4%) were missed diagnoses. A total of 86 causes of errors were identified, with the most common being related to clinical manifestation (45.3%) and the knowledge and cognitive errors of individuals (38.6%). The draft guidelines to reduce diagnostic errors included nine measures for addressing clinical manifestation, focusing on psychiatric evaluation, and five measures for addressing knowledge and cognitive errors, covering activities such as root cause analysis, cognitive errors monitoring, and strategies for de-biasing. The revised guideline based on expert opinions had an average IOC of 1.

Conclusion: The guidelines to reduce diagnostic errors in psychiatric diagnosis developed in this study are based on real-world findings. They specifically address errors arising from clinical manifestations as well as the knowledge and cognitive biases of individuals, demonstrating acceptable content validity and suitability for applying in hospitals with psychiatrists.