TY - JOUR T1 - Reaching 95%: decision support tools are the surest way to improve diagnosis now JF - BMJ Quality & Safety JO - BMJ Qual Saf DO - 10.1136/bmjqs-2021-014033 SP - bmjqs-2021-014033 AU - Mark L Graber Y1 - 2021/10/12 UR - http://qualitysafety.bmj.com/content/early/2021/10/12/bmjqs-2021-014033.abstract N2 - Rory Staunton, a 12 year-old boy, presented with fever, vomiting and mottled skin. Was this gastroenteritis?Thomas Duncan’s symptoms were headache, dizziness, nausea, abdominal pain and fever after recent travel from West Africa. Was this sinusitis?These two classic cases of diagnostic error beg the question of why the correct diagnosis was missed, and in his classic paper, George Bordage provided a very plausible answer: ‘I just didn’t think of it.’1 That is where clinical decision support tools for diagnosis (CDS-Dx), the so-called ‘symptom checkers’, come in. They work, and would likely have helped the clinicians consider the correct diagnosis in these cases: Rory Staunton’s streptococcal sepsis2 or Thomas Duncan’s Ebola infection,3 both of which had a fatal outcome.The report by Sibbald et al published in this issue of BMJ Quality & Safety adds to the growing evidence that decision support can improve the diagnostic process.4 This study was conducted at six different schools, and asked trainees and staff in internal medicine or emergency medicine to diagnose a series of challenging cases using the ‘Isabel’ CDS-Dx platform either early (right after the chief complaint) or later (after reviewing all of the relevant clinical information) in the diagnostic process. Students and residents included more diseases in their consideration with early use of the ‘Isabel’ CDS-Dx platform, a finding that could be important in improving diagnosis education. The most dramatic finding in the study was that later use, which is likely how it will be used in practice, improved the likelihood that the correct diagnosis would be included in the differential by 8%. Moreover, physicians said that using the software was easy and relatively fast.To put this result in context, the incidence of diagnostic error in primary care practice is roughly 10%; we get it right … ER -