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Official Journal of the Society to Improve Diagnosis in Medicine (SIDM)

Editor-in-Chief: Graber, Mark L. / Plebani, Mario

Ed. by Argy, Nicolas / Epner, Paul L. / Lippi, Giuseppe / McDonald, Kathryn / Singh, Hardeep

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Simulation and the diagnostic process: a pilot study of trauma and rapid response teams

Lindsay L. Juriga
  • Department of Anesthesiology, Division of Pediatric Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ David J. Murray
  • Corresponding author
  • Division of Pediatric Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA
  • Email
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ John R. Boulet
  • Research and Data Resources, Foundation for Advancement of International Medical Education and Research, Philadelphia, PA, USA
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ James J. Fehr
  • Division of Pediatric Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
Published Online: 2017-07-28 | DOI: https://doi.org/10.1515/dx-2017-0010



Simulation is frequently used to recreate many of the crises encountered in patient care settings. Teams learn to manage these crises in an environment that maximizes their learning experiences and eliminates the potential for patient harm. By designing simulation scenarios that include conditions associated with diagnostic errors, teams can experience how their decisions can lead to errors. The purpose of this study was to assess how trauma teams (TrT) and pediatric rapid response teams (RRT) managed scenarios that included a diagnostic error.


We developed four scenarios that would require TrT and pediatric RRT to manage an error in diagnosis. The two trauma scenarios (spinal cord injury and tracheobronchial tear) were designed to not respond to the heuristic management approach frequently used in trauma settings. The two pediatric scenarios (foreign body aspiration and coarctation of the aorta) had an incorrect diagnosis on admission. Two raters independently scored the scenarios using a rating system based on how teams managed the diagnostic process (search, establish and confirm a new diagnosis and initiate therapy based on the new diagnosis).


Twenty-one TrT and 17 pediatric rapid response managed 51 scenarios. All of the teams questioned the initial diagnosis. The teams were able to establish and confirm a new diagnosis in 49% of the scenarios (25 of 51). Only 23 (45%) teams changed their management of the patient based on the new diagnosis.


Simulation can be used to recreate conditions that engage teams in the diagnostic process. In contrast to most instruction about diagnostic error, teams learn through realistic experiences and receive timely feedback about their decision-making skills. Based on the findings in this pilot study, the majority of teams would benefit from an education intervention designed to improve their diagnostic skills.

Keywords: diagnostic process; education; patient safety; rapid response teams; simulation; trauma teams


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About the article

Corresponding author: David J. Murray, Director, Wood Simulation Center, Carol B. and Jerome T. Loeb Professor, Division of Pediatric Anesthesiology, Department of Anesthesiology, Washington University School of Medicine, Box 8054, St. Louis, MO, USA, Phone: +314-457-3116, Fax: +314-454-2296

Received: 2017-02-28

Accepted: 2017-06-24

Published Online: 2017-07-28

Published in Print: 2017-11-27

Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

Research funding: AHRQ: R18 HS022265-01 Murray, David John. Critical Care Management: A Simulation-Based Assessment of Decision-Making Skills. (Principle Investigator) 7/1/13-4/30/17.

AHRQ: RO1 HS018734-01, Murray [PI]. Teamwork, Communication and Decision-making: An Assessment Program Using Simulation. NIH Agency for Healthcare Research and Quality [AHRQ].

Employment or leadership: None declared.

Honorarium: None declared.

Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

Citation Information: Diagnosis, Volume 4, Issue 4, Pages 241–249, ISSN (Online) 2194-802X, ISSN (Print) 2194-8011, DOI: https://doi.org/10.1515/dx-2017-0010.

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