Making Diagnostic Uncertainty Visible at Intensive Care Unit Transitions: A Narrative Review of Diagnostic Pause Strategies

Authors

• Raha West, The Harley Street Clinic, HCA Healthcare UKFollow
• Ahmed ElHaddad, The Harley Street Clinic, HCA Healthcare UKFollow
• Behrad Baharlo, The Harley Street Clinic, HCA Healthcare UKFollow
• Parind Patel, The Harley Street Clinic, HCA Healthcare UKFollow

Keywords

diagnosis; diagnostic errors; diagnostic uncertainty; critical care; intensive care; intensive care unit; ICU transition; patient safety; handover; handoff; diagnostic pause; ICU-PAUSE

Disciplines

Critical Care

Abstract

Background

Diagnostic error is a significant patient safety issue in critical care. However, it is often difficult to detect during ongoing care. Patients in the Intensive Care Unit (ICU) often have incomplete histories, overlapping symptoms, changing physiology, and concurrent issues. During ICU transitions, patient diagnoses are often reported without clear information on diagnostic confidence, potential alternative diagnoses, pending results, or triggers needing review.

Methods

This clinical narrative review explored diagnostic uncertainty at ICU transitions, specifically those during ICU-to-ward transfers or unplanned escalations to the ICU. A targeted literature search identified studies of adult ICU diagnostic errors, ICU transition safety, ICU-PAUSE and diagnostic-pause literature, pediatric critical care diagnostic timeouts, and broader diagnostic safety reviews. A narrative approach was selected because the evidence was diverse and not suitable for meta-analysis.

Results

The literature indicates that diagnostic discrepancies occur in the ICU, that ICU transfers are high-risk periods for adverse events and communication failures, and that diagnostic-pause tools may help make uncertainty more visible. Although clinical outcome evidence remains limited, the safety rationale is strong.

Conclusion

A brief diagnostic pause can help ICU teams make diagnostic uncertainty explicit by asking: What is the working diagnosis? How certain are we? What else could be possible? What is still pending? What should prompt re-evaluation? Who owns the follow-up? Making these points explicit may support safer handovers, clearer follow-up and earlier diagnostic review after ICU transitions.

Recommended Citation

West, Raha; ElHaddad, Ahmed; Baharlo, Behrad; and Patel, Parind (2026) "Making Diagnostic Uncertainty Visible at Intensive Care Unit Transitions: A Narrative Review of Diagnostic Pause Strategies," HCA Healthcare Journal of Medicine: Vol. 7: Iss. 5, Article 11.
DOI: 10.36518/2689-0216.2616
Available at: https://scholarlycommons.hcahealthcare.com/hcahealthcarejournal/vol7/iss5/11