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Simple idea, significant implications

17 June 2019 | Avant media

For Professor Kumar Visvanathan (pictured), research is the natural way to unravel and clarify the questions that come up in clinical practice.

It was while treating patients in the emergency department (ED) he got the idea for his latest study, investigating the accuracy of pneumonia diagnosis in ED, which has received an Avant Foundation Grant.

Diagnosing pneumonia right 

Professor Visvanathan noticed more patients were being incorrectly diagnosed than he expected during his months on service in infectious diseases.

“It struck me that an important cause of hospital error is diagnostic error. Those who are incorrectly diagnosed with pneumonia may have a longer stay in hospital, higher readmission rates, greater exposure to antibiotics and, as a consequence, higher rates of C. difficile.”

This anecdotal experience was backed up by a literature review, which prompted Professor Visvanathan to undertake the study with a team of five researchers, each representing a link in the chain of pneumonia diagnosis.

“With digitisation we can now look back on hospital records efficiently, so we picked out all the diagnosed pneumonia cases over a two-year period and quantified diagnostic accuracy using medical records, focusing on symptoms, investigations and radiology.

“We haven’t finished our analysis yet but we’re well on our way. Looks to be about 30% of pneumonia diagnoses are incorrect. Now we have to look for interventions, because there is the opportunity to make a big difference,” he enthuses.

Next steps

The results of the analysis will help inform the development of strategies to improve diagnostic accuracy.

On this Professor Visvanathan says, “There are different ways you can go about this and it’s tempting to address it with education. But 

I don’t think education per se is a problem.  I think it’s more related to the pressure young doctors are under.

"Pilots go through a checklist to make sure everything's secure before they fly. In the same way, I think we can do up a checklist for diagnosing pneumonia so we know the diagnosis is more definitive.”

Optimising communication and workforce culture may also be important to improve diagnosis.

He’s enthusiastic about the research’s potential: “If we can improve diagnostic accuracy we can improve patient outcomes, as well as ensure resources are used more effectively. By lowering the unnecessary use of broad spectrum antibiotics in our own context, we may see real and tangible clinical benefits in our patient population and the antimicrobial resistance profile of the hospital”.

“This initiative could effect real change and rapid improvement in a common area of diagnostic error. This will result in a reduction of risk for practitioners and have significant benefits for patients. We’re proud to be able to fund this study which will go some way to improving quality and safety in EDs,” said Dr Penny Browne, Head of the Avant Foundation Board.

This article was originally published in Connect Issue 12.

Professor Kumar Visvanathan is Deputy Chair of the Department of Medicine at the University of Melbourne and Consultant Infectious Diseases Specialist at St Vincent’s Hospital.

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