Prashant Mahajan, Cynthia Mollen1, Elizabeth R Alpern2, Kelly Baird-Cox3, Richard C Boothman4, James M Chamberlain5, Karen Cosby6, Helene M Epstein7, Jennifer Gegenheimer-Holmes3, Michael Gerardi8, Traber D Giardina9, Vimla L Patel10, Richard Ruddy11, Jason Saleem12, Kathy N Shaw1, Dean F Sittig13, Hardeep Singh9. 1. Division of Pediatric Emergency Medicine, Department Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. 2. Division of Pediatric Emergency Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois. 3. From the Departments of Emergency Medicine. 4. Department of Surgery, University of Michigan Medical School, Ann Arbor, Michigan. 5. Division of Pediatric Emergency Medicine, Department of Pediatrics, Children's National Health System, Washington, District of Columbia. 6. Emergency Medicine, Cook County Hospital (Stroger) and Rush Medical School, Chicago, Illinois. 7. Member of the Board of Directors, Brightpoint Care, New York, New York. 8. Emergency Medicine, Morristown Medical Center and Goryeb Children's Hospital, Morristown, New Jersey. 9. Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas. 10. Center for Cognitive Studies in Medicine and Public Health, The New York Academy of Medicine, New York, New York. 11. University of Cincinnati College of Medicine, Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. 12. Industrial Engineering, University of Louisville, Louisville, Kentucky. 13. School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, Texas.
Abstract
OBJECTIVE: To create an operational definition and framework to study diagnostic error in the emergency department setting. METHODS: We convened a 17-member multidisciplinary panel with expertise in general and pediatric emergency medicine, nursing, patient safety, informatics, cognitive psychology, social sciences, human factors, and risk management and a patient/caregiver advocate. We used a modified nominal group technique to develop a shared understanding to operationally define diagnostic errors in emergency care and modify the National Academies of Sciences, Engineering, and Medicine's conceptual process framework to this setting. RESULTS: The expert panel defined diagnostic errors as "a divergence from evidence-based processes that increases the risk of poor outcomes despite the availability of sufficient information to provide a timely and accurate explanation of the patient's health problem(s)." Diagnostic processes include tasks related to (a) acuity recognition, information and synthesis, evaluation coordination, and (b) communication with patients/caregivers and other diagnostic team members. The expert panel also modified the National Academies of Sciences, Engineering, and Medicine's diagnostic process framework to incorporate influence of mode of arrival, triage level, and interventions during emergency care and underscored the importance of outcome feedback to emergency department providers to promote learning and improvement related to diagnosis. CONCLUSIONS: The proposed operational definition and modified diagnostic process framework can potentially inform the development of measurement tools and strategies to study the epidemiology and interventions to improve emergency care diagnosis.
OBJECTIVE: To create an operational definition and framework to study diagnostic error in the emergency department setting. METHODS: We convened a 17-member multidisciplinary panel with expertise in general and pediatric emergency medicine, nursing, patient safety, informatics, cognitive psychology, social sciences, human factors, and risk management and a patient/caregiver advocate. We used a modified nominal group technique to develop a shared understanding to operationally define diagnostic errors in emergency care and modify the National Academies of Sciences, Engineering, and Medicine's conceptual process framework to this setting. RESULTS: The expert panel defined diagnostic errors as "a divergence from evidence-based processes that increases the risk of poor outcomes despite the availability of sufficient information to provide a timely and accurate explanation of the patient's health problem(s)." Diagnostic processes include tasks related to (a) acuity recognition, information and synthesis, evaluation coordination, and (b) communication with patients/caregivers and other diagnostic team members. The expert panel also modified the National Academies of Sciences, Engineering, and Medicine's diagnostic process framework to incorporate influence of mode of arrival, triage level, and interventions during emergency care and underscored the importance of outcome feedback to emergency department providers to promote learning and improvement related to diagnosis. CONCLUSIONS: The proposed operational definition and modified diagnostic process framework can potentially inform the development of measurement tools and strategies to study the epidemiology and interventions to improve emergency care diagnosis.
Authors: Edward Harwick; Rebecca J Schwei; Robert Glinert; Ambar Haleem; Jamie Hess; Thomas Keenan; Joseph A McBride; Robert Redwood; Michael S Pulia Journal: J Am Coll Emerg Physicians Open Date: 2022-04-18
Authors: Kenneth A Michelson; David N Williams; Arianna H Dart; Prashant Mahajan; Emily L Aaronson; Richard G Bachur; Jonathan A Finkelstein Journal: Diagnosis (Berl) Date: 2020-06-26