Identifying trigger concepts to screen emergency department visits for diagnostic errors
| Autor: | Sarah J. Parker, Kathy N. Shaw, Karen S. Cosby, Robert El-Kareh, Mark L. Graber, Laura N. Medford-Davis, Traber Davis Giardina, Richard M. Ruddy, Divvy K. Upadhyay, Chih Wen Pai, James M. Chamberlain, Helene M. Epstein, Cynthia J. Mollen, Hardeep Singh, Elizabeth R. Alpern, Prashant Mahajan, Richard P. Medlin |
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| Rok vydání: | 2020 |
| Předmět: |
Emergency Medical Services
Safety Management medicine.medical_specialty Clinical Biochemistry Psychological intervention Medicine (miscellaneous) 03 medical and health sciences Patient safety 0302 clinical medicine Multidisciplinary approach Epidemiology Electronic Health Records Humans Medicine 030212 general & internal medicine Diagnostic Errors Risk management business.industry Health Policy Biochemistry (medical) Public Health Environmental and Occupational Health 030208 emergency & critical care medicine Emergency department medicine.disease Harm Hospital admission Medical emergency Emergency Service Hospital business |
| Zdroj: | Diagnosis. 8:340-346 |
| ISSN: | 2194-802X 2194-8011 |
| Popis: | Objectives The 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. Methods We 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. Results Six 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. Conclusions We 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. |
| Databáze: | OpenAIRE |
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