Table 4

Thematic analysis of focus groups after diagnostic pauses

Heightened risks in ambulatory care for diagnostic error‘Outpatient providers are very solo in their care. There’s so much that goes on between you and the patient that is never—there’s not anyone else in the room.’
‘At some point, with hand-offs, both inpatient and outpatient, we have to take our colleagues’ opinions at their face value. I don’t think with every patient we have the ability to go and review the primary data every time.’
The brevity of the diagnostic pause tool as a necessity‘It was pretty pain free as far as these go, I would say. There was this brief, it took maybe a minute max to actually complete it.’
The value of real-time, rather than delayed, alerts‘What I was thinking as I was doing it, was that if there were a way to bring that to bear in real time, either kind of at the time of the visit, or I don’t know exactly how that would work, but that something says, okay, ding-ding-ding, this is the second time someone is coming in.’
‘I think during the time that you’re actually seeing the patient, if there’s some way you can get that alert, ‘The patient’s being seen for a second time; is this really what you think is going on?’ would be sufficient.’
‘If the questions posed in the email survey would have happened when I was seeing the patient, it would’ve been more meaningful to my care of the patient.’
The extendibility of diagnostic pauses‘Separate from the survey, I think it did raise my awareness about cognitive timeouts. There’s definitely a situation related to having been in this study where I was seeing a patient, the first time he presented, where I did take a step back in my own mind and think about it.’
‘It brings up a good point that we really should be doing this with all our patients.’
‘Yeah, I can’t think of specific situations where it helped for that individual patient. I think that it’s certainly, just being in the study in general, and having periodic reminders to not get caught and deeply anchored, I think. [Because] we know we need that help.’
The need to identify the high-risk cohort of patients‘I guess the larger issue that it made me think of is, ‘Is there a certain patient characteristic or a provider characteristic that goes into what information we can take at face value and when we need to do a cognitive timeout?’’
‘It’s like trying to identify your high-risk patients for transitions, who is more likely to get readmitted. It’s the same thing; who are those patients that we need to do these cognitive timeouts to prevent either revisit to clinic or hospitalization or an adverse event or whatnot?’
‘It’s good because in situations where I really do need to actually second guess myself, it’s valuable, but it wasn’t needed in this case. I guess just learning over time, going back to which patients do I actually need to do the cognitive timeout or not.’