The QUID Prompt

☐ Have I verified past diagnostic labels?

☐ Do I have a clear picture of what happened over time?

☐ What is the trend?

☐  Have I

• examined the patient, including vital signs?

• considered risk factors?*

• considered complications?

• reviewed all investigations?

• considered medications?

• listened to the concerns of the patient/family/staff?

☐  Who else has useful information (nursing, ambulance, GP, allied health, other specialties and services)?

* E.g., extremes of age, pregnancy, immunocompromise, comorbidities, homelessness, IVDU, disability, etc.

☐ What else could this be (ddx)?

☐ What does not fit or cannot be explained?

☐ Are there any red flags?

☐ What are the not-to-be missed dx? **

☐ Do they look as well/unwell as expected?

 ** Have I considered the big three differentials (vascular, malignancy, infection)?

☐ Is my reasoning faulty or biased? *** 

☐ Am I tired, hungry, stressed, overworked?

☐ Is the patient eliciting negative emotions in me? 

☐ Am I distracted, interrupted, overloaded with information?

☐ Do I need a time-out to think?

*** Common biases include premature closure, confirmation bias, availability bias, anchoring, and group think.

☐ Have I let my team know?

☐ Have I shared my reasoning with the patient/family/others?

☐ Do I need advice from someone who may know more about this?

☐ Could this be time-critical?

☐ Do I need to escalate to ensure timely actions?

☐ Is the patient in the right place for their problem (e.g., ward, ICU, theatre)? 

☐ Am I seeing the expected response to treatment? 

☐ Is the patient/family/staff expressing concern? 

☐ Is the patient deteriorating? 

☐ Is there new information that doesn’t fit the working diagnosis?

If the patient is not responding as expected, or is deteriorating, or if anyone is expressing their concern to me, or there is new information, I need to return to the first prompt to think about the problem again thoroughly.