SHM Converge Scientific Abstract ePoster Gallery-An Ehr-Integrated Intervention to Prevent Diagnostic Errors in Acute Care

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This study evaluated an EHR-integrated intervention designed to reduce diagnostic errors (DEs) in hospitalized general medicine patients. The intervention targeted common diagnostic process failures and included three components: a DE risk-stratification algorithm, a patient diagnostic questionnaire, and a 5-step Diagnostic Time-Out (DTO). Because of COVID-19, implementation relied on virtual training, brief videos, a podcast, and monthly case-based newsletters.<br /><br />The authors used a pre-post implementation design and reviewed 675 stratified patient cases (339 pre-implementation, 336 post-implementation) drawn from a much larger hospitalized population. Patients were grouped into high-risk and low-risk cohorts based on trigger events such as ICU transfer, death within 90 days, or other clinical warning signs. Diagnostic outcomes were assessed by trained hospitalist adjudicators using validated SAFER Dx methods, with expert review for disagreements.<br /><br />Estimated population rates suggested that about 18.7% of cases involved a diagnostic error and 10.4% involved harmful diagnostic error. Overall, there was a non-significant reduction in overall DEs after implementation. However, post hoc subgroup analyses suggested benefit in high-risk patients, with reductions in harmful DEs compared with the pre-implementation period. Specifically, harmful DEs related to either primary or secondary diagnoses were lower in high-risk cohorts after implementation.<br /><br />The study concludes that while the overall pre-post effect was not statistically significant, the intervention may be promising for high-risk patients. The DTO, implementation materials, and structured case review process deserve further study. Major limitations included limited sample size, low statistical power, the observational pre-post design, and confounding from the COVID-19 pandemic.

Asset Subtitle

Anuj K. Dalal

Meta Tag

Author List Alison Garber, Alyssa Lam, Anuj K. Dalal, Cathy Yoon, Daniel Motta-Calderon, David W. Bates, Jackie Griffin, Jeffrey L. Schnipper, Julie Fiskio, Kaitlyn A. Konieczny, Maria Malik, Marie Leeson, Nicholas Piniella, Pamela Garabedian, Ronen Rozenblum, S

Category Research

Concept Diagnostic Errors

Concept National Diagnostic Safety Intervention

Concept Risk Stratification Algorithm

Concept Diagnostic Time-Out

Concept Diagnostic Error Rate

Distinguished Non-Finalist

Presenter Organization Brigham and Women's Hospital

Presenter Organization Harvard Medical School

Presenting Author Anuj K. Dalal

Track Patient Safety

Keywords

electronic health record

diagnostic errors

hospital medicine

diagnostic time-out

risk stratification

patient questionnaire

implementation study

harmful diagnostic error

pre-post design

COVID-19 pandemic

Diagnostic Errors

National Diagnostic Safety Intervention

Risk Stratification Algorithm

Diagnostic Time-Out

Diagnostic Error Rate