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Understanding diagnostic errors in medicine: a lesson from aviation
  1. H Singh1,
  2. L A Petersen1,
  3. E J Thomas2
  1. 1Division of Health Policy and Quality, Houston Center for Quality of Care and Utilization Studies, Michael E DeBakey Veterans Affairs Medical Center and Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, Texas, USA
  2. 2University of Texas Center of Excellence for Patient Safety Research and Practice; Division of General Medicine, Department of Medicine, University of Texas Medical School at Houston, Texas, USA
  1. Correspondence to:
 Dr H Singh
 VA Medical Center (152), 2002 Holcombe Blvd, Houston, TX 77030, USA;hardeeps{at}


The impact of diagnostic errors on patient safety in medicine is increasingly being recognized. Despite the current progress in patient safety research, the understanding of such errors and how to prevent them is inadequate. Preliminary research suggests that diagnostic errors have both cognitive and systems origins. Situational awareness is a model that is primarily used in aviation human factors research that can encompass both the cognitive and the systems roots of such errors. This conceptual model offers a unique perspective in the study of diagnostic errors. The applicability of this model is illustrated by the analysis of a patient whose diagnosis of spinal cord compression was substantially delayed. We suggest how the application of this framework could lead to potential areas of intervention and outline some areas of future research. It is possible that the use of such a model in medicine could help reduce errors in diagnosis and lead to significant improvements in patient care. Further research is needed, including the measurement of situational awareness and correlation with health outcomes.

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  • Funding: HS is the recipient of an NIH K12 Mentored Clinical Investigator Award grant number K12RR17665 to Baylor College of Medicine; LAP is a Robert Wood Johnson Foundation Generalist Physician Faculty Scholar (grant number 045444) and a recipient of the American Heart Association Established Investigator Award (grant number 0540043N); and EJT is supported by grant number 1PO1HS1154401 from the Agency for Healthcare Research and Quality

  • Competing interests: none.

  • The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs. HS is the responsible author.

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