SHM Converge Scientific Abstract ePoster Gallery-Leveraging Care Transitions to Identify Diagnostic Errors in Hospital Medicine

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This study examined whether hospital care transitions can be used to detect diagnostic errors. The authors focused on patients admitted to hospital medicine service from Thursday to Saturday and transferred from one hospitalist to another at the end of the service week. The incoming hospitalist received an electronic questionnaire about up to two patients, asking whether any diagnostic change had occurred. If a change was reported, trained reviewers independently assessed whether it reflected a diagnostic error, defined as a missed or delayed diagnosis, and whether patient harm occurred.<br /><br />The study found a 97% questionnaire response rate (621 of 641 completed) across 1,011 patients. The diagnostic error rate was 5.8%. The four main causes of error were: missing important information in the electronic health record, failure to consider the correct diagnosis, failure to order an appropriate test or consult, and missed physical exam findings.<br /><br />The authors note that this error rate is similar to rates reported in seven-day readmissions and in emergency department studies. Importantly, this is described as the first study to use diagnostic change at a care transition as the trigger for error review, rather than relying only on patient outcomes or retrospective chart review. Hospitalists reportedly received feedback on diagnostic changes and errors positively.<br /><br />The main conclusion is that care transitions offer a useful opportunity to identify and categorize diagnostic errors. Future work should develop better tools for efficiently reviewing the electronic health record, expand this approach to other settings such as the emergency department and internal medicine night float, and also identify diagnostic successes so feedback leads to learning and improvement.

Asset Subtitle

Gopi J. Astik

Meta Tag

Author List Andrew P.J Olson, Ashish Gupta, Danielle L. Steker, Gopi J. Astik, Jane S. Kim, Katherine Welter, Kevin J. O'Leary, Michelle Fletcher

Category Research

Concept Diagnostic Error

Concept Failure to Consider Diagnosis

Concept Diagnostic Error Rate

Concept Care Transition

Concept Chart Review

Distinguished Non-Finalist

Presenter Organization Northwestern University Feinberg School of Medicine

Presenting Author Gopi J. Astik

Track Patient Safety

Keywords

diagnostic errors

hospital care transitions

hospital medicine

diagnostic change

missed diagnosis

delayed diagnosis

electronic health record

patient safety

care transitions

hospitalist feedback

Diagnostic Error

Failure to Consider Diagnosis

Diagnostic Error Rate

Care Transition

Chart Review