Feasibility of patient-reported diagnostic errors following emergency department discharge: a pilot study

Diagnosis ◽  
2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Kelly T. Gleason ◽  
Susan Peterson ◽  
Cheryl R. Dennison Himmelfarb ◽  
Mariel Villanueva ◽  
Taylor Wynn ◽  
...  
Keyword(s):  
Emergency Department ◽  
Diagnostic Errors ◽  
Diagnostic Error ◽  
Health Concern ◽  
Future Research ◽  
Clinical Predictors ◽  
Patient Reported ◽  
Patient’S Experience ◽  
Emergency Department Discharge ◽  
Measured Response

AbstractObjectivesThe National Academy of Medicine identified diagnostic error as a pressing public health concern and defined failure to effectively communicate the diagnosis to patients as a diagnostic error. Leveraging Patient’s Experience to improve Diagnosis (LEAPED) is a new program for measuring patient-reported diagnostic error. As a first step, we sought to assess the feasibility of using LEAPED after emergency department (ED) discharge.MethodsWe deployed LEAPED using a cohort design at three EDs within one academic health system. We enrolled 59 patients after ED discharge and queried them about their health status and understanding of the explanation for their health problems at 2-weeks, 1-month, and 3-months. We measured response rates and demographic/clinical predictors of patient uptake of LEAPED.ResultsOf those enrolled (n=59), 90% (n=53) responded to the 2-week post-ED discharge questionnaire (1 and 3-month ongoing). Of the six non-responders, one died and three were hospitalized at two weeks. The average age was 50 years (SD 16) and 64% were female; 53% were white and 41% were black. Over a fifth (23%) reported they were not given an explanation of their health problem on leaving the ED, and of those, a fourth (25%) did not have an understanding of what next steps to take after leaving the ED.ConclusionsPatient uptake of LEAPED was high, suggesting that patient-report may be a feasible method of evaluating the effectiveness of diagnostic communication to patients though further testing in a broader patient population is essential. Future research should determine if LEAPED yields important insights into the quality and safety of diagnostic care.

scholarly journals 4021 Learning from Patient Experience to Improve Diagnosis: a Pilot Study

2020 ◽  
Vol 4 (s1) ◽  
pp. 138-139
Author(s):  
Kelly Gleason ◽  
Cheryl Dennison Himmelfarb ◽  
Susan Peterson ◽  
Taylor Wynn ◽  
Mariel Villanueva ◽  
...  
Keyword(s):  
Emergency Department ◽  
Health Status ◽  
Administrative Data ◽  
Health Problem ◽  
Chronic Obstructive Lung Disease ◽  
Diagnostic Error ◽  
Chronic Obstructive ◽  
Study Results ◽  
Patient Reported ◽  
Emergency Department Discharge

OBJECTIVES/GOALS: Leveraging Patient’s Experience to improve Diagnosis (LEAPED) is our proposed method of measuring diagnostic error through seeking patient feedback on their understanding of their diagnosis and health status following emergency department discharge. To pilot test LEAPED’s feasibility, we deployed and determined patient uptake of LEAPED. METHODS/STUDY POPULATION: To test LEAPED, we employed a longitudinal cohort study design at emergency departments across one academic health system in the Mid-Atlantic region. Patients consented to complete questionnaires regarding their understanding of their diagnosis and/or follow-up steps and their health status at 2 weeks, 1 month, and 3 months following emergency department discharge. People aged 18 and older who were seen at the emergency department within the past 7 days with at least one chronic condition (hypertension, diabetes, history of stroke, arthritis, cancer, heart disease, osteoporosis, depression, and/or chronic obstructive lung disease) and one or more of the following common chief complaints: chest pain, upper back pain, abdominal pain, shortness of breath/cough, dizziness, and headache were eligible to join the study. RESULTS/ANTICIPATED RESULTS: Of those enrolled (n = 59), 95% (n = 53) responded to the two week post-ED discharge questionnaire (1 and 3-month ongoing). Of the 6 non-responders, 1 had died and 3 were hospitalized at two weeks. The average age was 50 years (SD 16) and 64% were female. Over half of participants (53%) were white and 41% were black. Almost one-third (27%) reported they were not given an explanation of their health problem on leaving the ED, and of those, a third did not have an understanding of what steps to take after leaving the ED. Participants reported a new health problem was identified after ED discharge (19%), worsening health status (12%), and health status stayed the same (16%). DISCUSSION/SIGNIFICANCE OF IMPACT: Patient uptake of LEAPED was high, which suggests that patient-report is a feasible method of evaluating diagnostic decision making and delivery to patients and yields insightful information beyond administrative data. The next steps are to validate the accuracy of patient-reported diagnostic error by comparing with administrative data.

Identifying trigger concepts to screen emergency department visits for diagnostic errors

Diagnosis ◽  
2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Prashant Mahajan ◽  
Chih-Wen Pai ◽  
Karen S. Cosby ◽  
Cynthia J. Mollen ◽  
Kathy N. Shaw ◽  
...  
Keyword(s):  
Emergency Department ◽  
Expert Panel ◽  
Diagnostic Errors ◽  
Diagnostic Error ◽  
Emergency Department Visits ◽  
Therapeutic Interventions ◽  
Diagnostic Process ◽  
Future Research ◽  
Office Referrals ◽  
Vital Component

AbstractObjectivesThe diagnostic process is a vital component of safe and effective emergency department (ED) care. There are no standardized methods for identifying or reliably monitoring diagnostic errors in the ED, impeding efforts to enhance diagnostic safety. We sought to identify trigger concepts to screen ED records for diagnostic errors and describe how they can be used as a measurement strategy to identify and reduce preventable diagnostic harm.MethodsWe conducted a literature review and surveyed ED directors to compile a list of potential electronic health record (EHR) trigger (e-triggers) and non-EHR based concepts. We convened a multidisciplinary expert panel to build consensus on trigger concepts to identify and reduce preventable diagnostic harm in the ED.ResultsSix e-trigger and five non-EHR based concepts were selected by the expert panel. E-trigger concepts included: unscheduled ED return to ED resulting in hospital admission, death following ED visit, care escalation, high-risk conditions based on symptom-disease dyads, return visits with new diagnostic/therapeutic interventions, and change of treating service after admission. Non-EHR based signals included: cases from mortality/morbidity conferences, risk management/safety office referrals, ED medical director case referrals, patient complaints, and radiology/laboratory misreads and callbacks. The panel suggested further refinements to aid future research in defining diagnostic error epidemiology in ED settings.ConclusionsWe identified a set of e-trigger concepts and non-EHR based signals that could be developed further to screen ED visits for diagnostic safety events. With additional evaluation, trigger-based methods can be used as tools to monitor and improve ED diagnostic performance.

Patient-Reported Adverse Drug Related Events from Emergency Department Discharge Prescriptions

2007 ◽  
Vol 14 (5 Supplement 1) ◽  
pp. S194-S194
Author(s):  
C. Hohl ◽  
A.-R. Laban ◽  
P. Zed ◽  
J. Brubacher ◽  
G. Tsai ◽  
...  
Keyword(s):  
Emergency Department ◽  
Patient Reported ◽  
Emergency Department Discharge

scholarly journals Impact of diagnostic errors on adverse outcomes: learning from emergency department revisits with repeat CT or MRI

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Yura Ahn ◽  
Gil-Sun Hong ◽  
Kye Jin Park ◽  
Choong Wook Lee ◽  
Ju Hee Lee ◽  
...  
Keyword(s):  
Emergency Department ◽  
Diagnostic Errors ◽  
Diagnostic Error ◽  
Adverse Outcomes ◽  
Multivariable Logistic Regression Analysis ◽  
Imaging Studies ◽  
Neurologic Diseases ◽  
Logistic Analysis ◽  
Digestive Diseases ◽  
Repeat Imaging

Abstract Background To investigate diagnostic errors and their association with adverse outcomes (AOs) during patient revisits with repeat imaging (RVRIs) in the emergency department (ED). Results Diagnostic errors stemming from index imaging studies and AOs within 30 days in 1054 RVRIs (≤ 7 days) from 2005 to 2015 were retrospectively analyzed according to revisit timing (early [≤ 72 h] or late [> 72 h to 7 days] RVRIs). Risk factors for AOs were assessed using multivariable logistic analysis. The AO rate in the diagnostic error group was significantly higher than that in the non-error group (33.3% [77 of 231] vs. 14.8% [122 of 823], p < .001). The AO rate was the highest in early revisits within 72 h if diagnostic errors occurred (36.2%, 54 of 149). The most common diseases associated with diagnostic errors were digestive diseases in the radiologic misdiagnosis category (47.5%, 28 of 59) and neurologic diseases in the delayed radiology reporting time (46.8%, 29 of 62) and clinician error (27.3%, 30 of 110) categories. In the matched set of the AO and non-AO groups, multivariable logistic regression analysis revealed that the following diagnostic errors contributed to AO occurrence: radiologic error (odds ratio [OR] 3.56; p < .001) in total RVRIs, radiologic error (OR 3.70; p = .001) and clinician error (OR 4.82; p = .03) in early RVRIs, and radiologic error (OR 3.36; p = .02) in late RVRIs. Conclusion Diagnostic errors in index imaging studies are strongly associated with high AO rates in RVRIs in the ED.

scholarly journals Diagnostic delay of acute mitral regurgitation during the coronavirus disease 2019 pandemic: a case report

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Azumi Kawabata ◽  
Hiraku Funakoshi ◽  
Joji Ito ◽  
Takushi Santanda ◽  
Yasuhiro Norisue ◽  
...  
Keyword(s):  
Emergency Department ◽  
Mitral Regurgitation ◽  
Correct Diagnosis ◽  
Diagnostic Delay ◽  
Diagnostic Errors ◽  
Diagnostic Error ◽  
Delay In Diagnosis ◽  
Increased Risk ◽  
Anchoring Bias ◽  
Acute Mitral Regurgitation

Abstract Background Diagnostic errors or delays can cause serious consequences for patient safety, especially in the emergency department. Anchoring bias is one of the major factors leading to diagnostic error. During the coronavirus disease 2019 (COVID-19) pandemic, the high probability of COVID-19 in febrile patients could be a major cause of anchoring bias leading to diagnostic error. In addition, certain evaluations such as auscultation are difficult to perform on a casual basis due to the increased risk of contact infection, which lead to inadequate assessment of the patients with valvular disease. Acute mitral regurgitation (MR) could be a fatal disease in the emergency department, especially if there is a diagnostic error or delay in diagnosis. It is often reported that diagnosis can be difficult even though there is no treatment other than emergent surgery. The diagnosis of acute MR has become more difficult because coronavirus disease 2019 (COVID-19) pandemic could affect our daily practice especially in febrile patients. We report a case of a diagnostic delay of a febrile patient because of anchoring bias during the COVID-19 pandemic. Case presentation A 45-year-old man presented to the emergency department complaining of acute dyspnea and fever. Based on vital signs and computed tomography of the chest, acute pneumonia due to COVID-19 was suspected. Auscultation was avoided because of facility rule based on concern of contact infection. After admission to the intensive care unit, Doppler echocardiography revealed acute mitral regurgitation, and transesophageal echocardiography revealed mitral valve tendon rupture. After confirming the negative result for the polymerase chain reaction of severe acute respiratory syndrome coronavirus 2, mitral valvuloplasty was performed on the third day after admission. The patient was discharged 14 days after admission without complications. Conclusions In COVID-19 pandemic, anchoring bias suspecting COVID-19 among febrile patients becomes a strong heuristic factor. A thorough history and physical examination is still important in febrile patients presenting with dyspnea to ensure the correct diagnosis of acute mitral regurgitation.

Methodologies for evaluating strategies to reduce diagnostic error: report from the research summit at the 7th International Diagnostic Error in Medicine Conference

Diagnosis ◽  
2016 ◽  
Vol 3 (1) ◽  
pp. 1-7 ◽  
Author(s):  
Beau B. Bruce ◽  
Robert El-Kareh ◽  
John W. Ely ◽  
Michael H. Kanter ◽  
Goutham Rao ◽  
...  
Keyword(s):  
Randomized Clinical Trials ◽  
Diagnostic Errors ◽  
Interrupted Time Series ◽  
Diagnostic Error ◽  
Current Evidence ◽  
Future Research ◽  
Error Mitigation ◽  
Safety Research ◽  
Diagnostic Research ◽  
Cluster Randomized

AbstractIn this article we review current evidence on strategies to evaluate diagnostic error solutions, discuss the methodological challenges that exist in investigating the value of these strategies in patient care, and provide recommendations for methods that can be applied in investigating potential solutions to diagnostic errors. These recommendations were developed iteratively by the authors based upon initial discussions held during the Research Summit of the 7th Annual Diagnostic Error in Medicine Conference in September 2014. The recommendations include the following elements for designing studies of diagnostic research solutions: (1) Select direct and indirect outcomes measures of importance to patients, while also practical for the particular solution; (2) Develop a clearly-stated logic model for the solution to be tested; (3) Use rapid, iterative prototyping in the early phases of solution testing; (4) Use cluster-randomized clinical trials where feasible; (5) Avoid simple pre-post designs, in favor of stepped wedge and interrupted time series; (6) Leverage best practices for patient safety research and engage experts from relevant domains; and (7) Consider sources of bias and design studies and their analyses to minimize selection and information bias and control for confounding. Areas of diagnostic error mitigation research identified for further attention include: role of competing diagnoses, understanding the impacts of organizational culture, timing of diagnosis, and sequencing of research studies. Future research will likely require novel clinical, health services, and qualitative research methods to address the age-old problem of arriving at an accurate diagnosis.

scholarly journals Association between primary care physician diagnostic knowledge and death, hospitalisation and emergency department visits following an outpatient visit at risk for diagnostic error: a retrospective cohort study using medicare claims

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e041817
Author(s):  
Bradley M Gray ◽  
Jonathan L Vandergrift ◽  
Rozalina G McCoy ◽  
Rebecca S Lipner ◽  
Bruce E Landon
Keyword(s):  
Primary Care ◽  
At Risk ◽  
Emergency Department ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Diagnostic Errors ◽  
Diagnostic Error ◽  
Adverse Outcomes ◽  
Ed Visits

ObjectiveDiagnostic error is a key healthcare concern and can result in substantial morbidity and mortality. Yet no study has investigated the relationship between adverse outcomes resulting from diagnostic errors and one potentially large contributor to these errors: deficiencies in diagnostic knowledge. Our objective was to measure that associations between diagnostic knowledge and adverse outcomes after visits to primary care physicians that were at risk for diagnostic errors.Setting/participants1410 US general internists who recently took their American Board of Internal Medicine Maintenance of Certification (ABIM-IM-MOC) exam treating 42 407 Medicare beneficiaries who experienced 48 632 ‘index’ outpatient visits for new problems at risk for diagnostic error because the presenting problem (eg, dizziness) was related to prespecified diagnostic error sensitive conditions (eg, stroke).Outcome measures90-day risk of all-cause death, and, for outcome conditions related to the index visits diagnosis, emergency department (ED) visits and hospitalisations.DesignUsing retrospective cohort study design, we related physician performance on ABIM-IM-MOC diagnostic exam questions to patient outcomes during the 90-day period following an index visit at risk for diagnostic error after controlling for practice characteristics, patient sociodemographic and baseline clinical characteristics.ResultsRates of 90-day adverse outcomes per 1000 index visits were 7 for death, 11 for hospitalisations and 14 for ED visits. Being seen by a physician in the top versus bottom third of diagnostic knowledge during an index visit for a new problem at risk for diagnostic error was associated with 2.9 fewer all-cause deaths (95% CI −5.0 to −0.7, p=0.008), 4.1 fewer hospitalisations (95% CI −6.9 to −1.2, p=0.006) and 4.9 fewer ED visits (95% CI −8.1% to −1.6%, p=0.003) per 1000 visits.ConclusionHigher diagnostic knowledge was associated with lower risk of adverse outcomes after visits for problems at heightened risk for diagnostic error.

scholarly journals Patient-reported adverse drug-related events from emergency department discharge prescriptions

CJEM ◽  
2010 ◽  
Vol 12 (04) ◽  
pp. 331-338 ◽  
Author(s):  
Corinne M. Hohl ◽  
Riyad B. Abu-Laban ◽  
Peter J. Zed ◽  
Jeffrey R. Brubacher ◽  
Gina Tsai ◽  
...  
Keyword(s):  
Emergency Department ◽  
Tertiary Care ◽  
Time Frame ◽  
Tertiary Care Centre ◽  
Crude Odds Ratio ◽  
Patient Reported ◽  
Scale Scores ◽  
Emergency Department Triage ◽  
Emergency Department Discharge ◽  
Research Assistants

ABSTRACTObjective:The tolerability of drugs prescribed on emergency department (ED) discharge is unknown. Our objectives were to quantify and describe adverse drug-related events (ADREs) as reported by patients triaged as Canadian Emergency Department Triage and Acuity Scale scores 3, 4 or 5, discharged from the ED with prescriptions.Methods:This prospective observational study was a planned substudy of a larger study on adherence to discharge prescriptions. This study was conducted in a tertiary care centre with an annual ED census of 69 000 visits. The primary outcome was the frequency of ADREs reported during a structured telephone questionnaire 2 weeks after ED discharge. An ADRE was deemed to have occurred if the patient reported a symptom consistent with a known ADRE that began and resolved within a plausible time frame after starting and stopping the drug, and if no alternative diagnosis was probable.Results:Research assistants contacted 258/301 (85.7%) patients discharged from the ED with a prescription. An ADRE was reported by 54/258 patients (20.9%, 95% confidence interval [CI] 16.4%–26.3%). The most commonly reported ADREs were nausea, constipation and drowsiness. None required hospital admission or caused death. Participants reporting ADREs were not more likely to make an unplanned ED or clinic revisit (crude odds ratio [OR] 1.1, 95% CI 0.6–2.2; adjusted OR 1.2, 95% CI 0.6–2.4).Conclusion:Approximately one-fifth of low-acuity patients prescribed medication on discharge from the ED report ADREs, but most of these are neither severe nor associated with an increase in use of health services. Attention to common preventable ADREs, such as opioid-associated constipation, could reduce the rate of ADREs in this population.

scholarly journals Characterizing Potentially Preventable Cancer- and Chronic Disease–Related Emergency Department Use in the Year After Treatment Initiation: A Regional Study

2018 ◽  
Vol 14 (3) ◽  
pp. e176-e185 ◽  
Author(s):  
Laura Panattoni ◽  
Catherine Fedorenko ◽  
Mikael Anne Greenwood-Hickman ◽  
Karma Kreizenbeck ◽  
Julia R. Walker ◽  
...  
Keyword(s):  
Emergency Department ◽  
Chronic Disease ◽  
Treatment Initiation ◽  
Care Delivery ◽  
Primary Diagnosis ◽  
Future Research ◽  
Regional Study ◽  
Cancer Symptoms ◽  
Patient Reported ◽  
Ed Visits

Purpose: As new quality metrics and interventions for potentially preventable emergency department (ED) visits are implemented, we sought to compare methods for evaluating the prevalence and costs of potentially preventable ED visits that were related to cancer and chronic disease among a commercially insured oncology population in the year after treatment initiation. Methods: We linked SEER records in western Washington from 2011 to 2016 with claims from two commercial insurers. The study included patients who were diagnosed with a solid tumor and tracked ED utilization for 1 year after the start of chemotherapy or radiation. Cancer symptoms from the Centers for Medicare & Medicaid Services metric and a patient-reported outcome intervention were labeled potentially preventable (PpCancer). Prevention Quality Indicators of the Agency for Healthcare Research and Quality were labeled potentially preventable–chronic disease (PpChronic). We reported the primary diagnosis, all diagnosis field coding (1 to 10), and 2016 adjusted reimbursements. Results: Of 5,853 eligible patients, 27% had at least one ED visit, which yielded 2,400 total visits. Using primary diagnosis coding, 49.8% of ED visits had a PpCancer diagnosis, whereas 3.2% had a PpChronic diagnosis. Considering all diagnosis fields, 45.0%, 9.4%, and 18.5% included a PpCancer only, a PpChronic only, and both a PpCancer and a PpChronic diagnosis, respectively. The median reimbursement per visit was $735 (interquartile ratio, $194 to $1,549). Conclusion: The prevalence of potentially preventable ED visits was generally high, but varied depending on the diagnosis code fields and the group of codes considered. Future research is needed to understand the complex landscape of potentially preventable ED visits and measures to improve value in cancer care delivery.

Use of Reflective Practice to Increase Diagnostic Accuracy

2016 ◽  
Vol 5 (1) ◽  
pp. 134-139
Author(s):  
Martin Caliendo ◽  
Joanna Abraham
Keyword(s):  
Diagnostic Accuracy ◽  
Reflective Practice ◽  
Patient Outcomes ◽  
Evaluation Studies ◽  
Diagnostic Errors ◽  
Empirical Support ◽  
Diagnostic Error ◽  
Future Research ◽  
Information Synthesis ◽  
Methodological Foundation

Diagnostic error accounts for up to 17 percent of all adverse patient outcomes. Cognitive errors, in particular faulty information synthesis, accounts for the majority of these diagnostic errors. Reflective practice is reported as a strategy to improve diagnostic accuracy. The theoretic foundation to use reflective practice to decrease diagnostic error is well developed; however, empirical support is lacking and inconsistent. To address this gap, the author conducted an integrative review to critically evaluate the evidence in support of intervention for training in reflective practice to improve the diagnostic accuracy of clinicians’ decision making. We discuss our findings on the analytical, theoretical and methodological foundation of current evaluation studies on training in reflective practice patterns, in addition to identifying gaps in knowledge that will guide potential areas for future research.

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