A Deeper Look to Prevent Delayed Diagnosis & Errors using Long Wave Infrared Thermography (LWIT)

Introduction: Diagnostic errors are a common and costly risk for patient harm.1 They occur when a healthcare provider fails to establish an accurate and timely explanation of a patient's health problem and/or communicate this explanation to the patient.2 The Agency for Healthcare Research and Quality (AHRQ) has published recommendations reinforcing the value of nurses' roles in diagnostic safety and encouraging the strengthening of nurses’ roles in the diagnostic process.1 This practice innovation aimed to gather objective assessment data for prompt diagnostic accuracy.Methods:The rehabilitation hospital wound care specialist initiates Long Wave Infrared Thermography (LWIT) during the bedside assessment of wounds and incisions. The LWIT immediately produces thermal images to compare the concerned site's relative temperature differential (RTD) to healthy tissue.   The LWIT identifies pathophysiologic changes that are not visible. Warm temperatures may indicate inflammation or infection, and cool temperatures may indicate decreased perfusion. The wound nurse communicates the objective findings.Results:The initial image identifies non-visual assessment data; repeated images confirm treatment efficiency. Case A: Liver transplant without redness or drainage; RTD around the incision revealed an increase of 4 ˚C. "LWIT helped to identify an infection and start treatment." Case B: The colostomy and hernia repair patient had pain and slight redness (0.5cm) at the mid-incision. LWIT imaging to rule out an abscess. The nurse identified an RTD increase of +1.8 ˚C in the painful area. Antibiotics were promptly started. Case C: Motor Vehicle Accident, with multiple fractures and non-operable subdural hematoma, incontinence of bowel and bladder, unstageable pressure ulcer (PI), urine cultures positive, and white blood count 17.3.   LWIT image of the wound identified an RTD increase at the coccyx/sacral of 4.3 ˚C, which prompted bone culture, confirming osteomyelitis. LWIT helped avoid delayed or missed diagnoses, which contribute to patient harm.4      Discussion: Nursing intuition prompted using LWIT in these cases; explaining decisions based on intuition alone can be challenging.3 LWIT measurements provided quantifiable data to communicate concerns.  Diagnosis is a physician/provider's responsibility and not within the nursing scope of practice. However, nurses are essential to a team-based approach and are crucial to help achieve diagnostic excellence.1 References:1. Tran AK, Calabrese M, Quatrara B, Goeschel C. Reinforcing the Value and Roles of Nurses in Diagnostic Safety: Pragmatic Recommendations for Nurse Leaders and Educators. Rockville, MD: Agency for Healthcare Research and Quality; September 2022. AHRQ Publication No. 22-0026-4-EF. 2. Defining diagnostic error: a scoping review to assess the impact of the national academies' report improving diagnosis in health care. Giardina TD, Hunte H, Hill MA, Heimlich SL, Singh H, Smith KM. J Patient Saf 2022 3. Melin-Johansson C, Palmqvist R, Rönnberg L. Clinical intuition in the nursing process and decision-making-A mixed-studies review. J Clin Nurs. 2017 Dec;26(23-24):3936-3949. doi: 10.1111/jocn.13814. Epub 2017 Jun 22. PMID: 28329439. 4. Calibrate Dx: A Resource To Improve Diagnostic Decisions. Content last reviewed March 2023. Agency for Healthcare Research and Quality, Rockville, MD. https://www.ahrq.gov/diagnostic-safety/tools/calibrate-dx.html accessed 3/1423