Application of a Machine Learning to Enhance e-Triggers to Detect and Learn from Diagnostic Safety Events

Citation:
Kapadia P, Zimolzak AJ, Upadhyay DK, Korukonda S, Murugaesh Rekha R, Mushtaq U, Mir U, Murphy DR, Offner A, Abel GA, Lyratzopoulos G, Mounce LTA, Singh H. Development and Implementation of a Digital Quality Measure of Emergency Cancer Diagnosis. J Clin Oncol. 2024 Jul 20;42(21):2506-2515. doi: 10.1200/JCO.23.01523. Epub 2024 May 8. PMID: 38718321; PMCID: PMC11268555.

Summary:
This study developed and implemented a digital quality measure (dQM) to assess cancer emergency presentations (EP), defined as a new cancer diagnosis within 30 days after an emergency department or inpatient visit. The measure was applied to lung cancer and colorectal cancer (CRC) patients from the Department of Veterans Affairs (VA) and Geisinger health systems between 2016 and 2020. The dQM identified EPs in 20.9% of lung cancer and 22.4% of CRC cases at VA, and in 9.4% of lung cancer and 7.5% of CRC cases at Geisinger. Chart reviews confirmed the high accuracy of the dQM (72%-90% positive predictive value) and revealed that EPs often represented missed opportunities for diagnosis (MODs). The study found that EPs were significantly associated with higher 1-year mortality for both cancer types, highlighting the potential of automated quality measures to improve cancer diagnosis in health systems.

Citation:
Thirnbeck CK, Espinoza ET, Beaman EA, Rozen AL, Dukes KC, Singh H, Herwaldt LA, Landrigan CP, Reisinger HS, Cifra CL. Interfacility Referral Communication for PICU Transfer. Pediatr Crit Care Med. 2024 Jun 1;25(6):499-511. doi: 10.1097/PCC.0000000000003479. Epub 2024 Mar 14. PMID: 38483193; PMCID: PMC11153023.

Summary:
This study examined verbal handoffs during urgent interfacility transfers to the Pediatric Intensive Care Unit (PICU) and compared them to intrahospital shift-to-shift handoffs. Analysis of 49 audio-recorded referral calls showed that most clinicians provided key information such as patient history, physical exam findings, test results, and interventions, but less frequently discussed illness severity or code status. While 77% of referring clinicians and 6% of receiving PICU physicians stated the working diagnosis, only 9% of PICU physicians summarized the received information. The communication patterns shared similarities with intrahospital handoffs, but with differences in expertise and reliance on each other for accurate information. The findings suggest a need structured tools to improve PICU referral communication and enhance patient outcomes.

Citation:
Cifra CL, Custer JW, Smith CM, Smith KA, Bagdure DN, Bloxham J, Goldhar E, Gorga SM, Hoppe EM, Miller CD, Pizzo M, Ramesh S, Riffe J, Robb K, Simone SL, Stoll HD, Tumulty JA, Wall SE, Wolfe KK, Wendt L, Ten Eyck P, Landrigan CP, Dawson JD, Reisinger HS, Singh H, Herwaldt LA. Prevalence and Characteristics of Diagnostic Error in Pediatric Critical Care: A Multicenter Study. Crit Care Med. 2023 Nov 1;51(11):1492-1501. doi: 10.1097/CCM.0000000000005942. Epub 2023 May 30. PMID: 37246919;PMCID: PMC10615661.

Summary:
This multicenter study found that 1.5% of critically ill children admitted to PICUs had a diagnostic error within the first 7 days. Most errors involved missed infections and respiratory conditions, often due to overlooked diagnoses or insufficient testing. Errors were more common in cases with atypical presentations or diagnostic uncertainty at admission. Atypical presentations and diagnostic uncertainty were significantly associated with higher odds of error. These findings highlight potential targets for interventions to reduce diagnostic errors in PICUs.

Citation:
Sittig DF, Yackel EE, Singh H. Five Strategies for a Safer EHR Modernization Journey. J Gen Intern Med. 2023 Oct;38(Suppl 4):940-942. doi: 10.1007/s11606-023-08331-z. PMID: 37798588; PMCID: PMC10593716.

Summary:
This editorial explains the challenges of large-scale electronic health record (EHR) transitions, particularly within the VA. It proposes five strategies to mitigate these risks, including shared responsibility among stakeholders, staff empowerment, standardizing EHR workflows, optimizing system reliability, and centralizing safety assessments. These approaches aim to reduce patient harm and improve the long-term success of EHR implementation efforts.

Citation:
Kulkarni PA, Singh H. Artificial Intelligence in Clinical Diagnosis: Opportunities, Challenges, and Hype. JAMA. 2023 Jul 25;330(4):317-318. doi: 10.1001/jama.2023.11440. PMID: 37410477.

Summary:
This viewpoint discusses the potential of artificial intelligence (AI), particularly ChatGPT, to enhance diagnostic accuracy in healthcare. While AI could support the identification of rare conditions and ensure common diagnoses are considered, it cannot replicate key human qualities, such as empathy and nuanced clinical judgment, which are critical for effective patient interactions and accurate diagnosis.

Citation:
Zwaan L, Smith KM, Giardina TD, Hooftman J, Singh H. Patient generated research priorities to improve diagnostic safety: A systematic prioritization exercise. Patient Educ Couns. 2023 May;110:107650. doi: 10.1016/j.pec.2023.107650. Epub 2023 Jan 27. PMID: 36731167.

Summary:
This study engaged patients in setting research priorities for reducing diagnostic errors. Using the Child Health and Nutrition Research Initiative (CHNRI) methodology, patients generated and prioritized 171 research questions, ultimately identifying 10 top priorities. Key topics included improving care coordination, enhancing diagnostic error measurement, and addressing implicit bias in vulnerable patient groups. Patients’ priorities differed from researchers’ offering valuable insights to complement existing agendas. These patient-generated priorities can guide future research and funding efforts aimed at reducing diagnostic errors.

Citation:
Bradford A, Singh H. Building clinical pathways of the future that improve safety and reduce waste in healthcare. J Hosp Med. 2023 Feb;18(2):200-201. doi: 10.1002/jhm.13044. Epub 2023 Jan 12. PMID: 36633160.

Summary:
This article explores the future development of clinical pathways in healthcare with the goal of improving patient safety while minimizing waste. The researchers argue that leveraging data, technology, and evidence-based practices can help streamline care processes, reduce unnecessary tests or treatments, and ultimately enhance the efficiency of healthcare systems. The authors emphasize the importance of continuous evaluation and adaptation of clinical pathways to meet evolving patient needs. Additionally, they suggest that cross-disciplinary collaboration is essential to build more effective, patient-centered care models.

Citation:
Giardina TD, Hunte H, Hill MA, Heimlich SL, Singh H, Smith KM. Defining Diagnostic Error: A Scoping Review to Assess the Impact of the National Academies' Report Improving Diagnosis in Health Care. J Patient Saf. 2022 Dec 1;18(8):770-778. doi: 10.1097/PTS.0000000000000999. Epub 2022 Apr 27. PMID: 35405723; PMCID: PMC9698189.

Summary:
This scoping review examines the influence of the National Academies' report “Improving Diagnosis in Health Care” on defining and addressing diagnostic error. The review highlights the evolution of diagnostic error definitions and their implications for patient safety, emphasizing the importance of accurate diagnosis in healthcare. The authors explore how the report has influenced efforts to address diagnostic errors and improve healthcare quality.

Citation:
Meyer AND, Singh H, Zimolzak AJ, Wei L, Choi DT, Marinez AD, Murphy DR. Cancer Evaluations During the COVID-19 Pandemic: An Observational Study Using National Veterans Affairs Data. Am J Prev Med. 2022 Dec;63(6):1026-1030. doi: 10.1016/j.amepre.2022.07.004. Epub 2022 Aug 8. PMID: 36055880; PMCID: PMC9359503.

Summary:
This observational study uses national Veterans Affairs data to examine the impact of the COVID-19 pandemic on cancer evaluations. They found that the pandemic significantly disrupted cancer screening and diagnostic evaluations, which may have delayed diagnoses and impacted outcomes. The study highlights the need for strategies to mitigate these disruptions and ensure timely cancer care during public health crises.

Citation:
Sittig DF, Sherman JD, Eckelman MJ, Draper A, Singh H. i-CLIMATE: a "clinical climate informatics" action framework to reduce environmental pollution from healthcare. J Am Med Inform Assoc. 2022 Nov 14;29(12):2153-2160. doi: 10.1093/jamia/ocac137. PMID: 35997550; PMCID: PMC9667163.

Summary:
The article introduces the i-CLIMATE framework, a "clinical climate informatics" action plan designed to reduce environmental pollution in healthcare settings. The framework emphasizes using informatics to improve sustainability by reducing waste, optimizing energy use, and promoting eco-friendly practices in healthcare systems. The authors argue that integrating climate-conscious strategies into clinical workflows can significantly reduce the environmental footprint of healthcare without compromising patient care.

Citation:
Giardina TD, Shahid U, Mushtaq U, Upadhyay DK, Marinez A, Singh H. Creating a Learning Health System for Improving Diagnostic Safety: Pragmatic Insights from US Health Care Organizations. J Gen Intern Med. 2022 Nov;37(15):3965-3972. doi: 10.1007/s11606-022-07554-w. Epub 2022 Jun 1. PMID: 35650467; PMCID: PMC9640494.

Summary:
This article explores the creation of a learning health system to improve diagnostic safety in U.S. healthcare organizations. The study identifies key insights and strategies for integrating continuous learning and improvement in diagnostic practices, emphasizing the importance of organizational culture, data-driven approaches, and multidisciplinary collaboration. The authors argue that these elements are crucial for reducing diagnostic errors and enhancing patient safety.

Citation:
Savoy A, Patel H, Shahid U, Offner AD, Singh H, Giardina TD, Meyer AND. Electronic Co-design (ECO-design) Workshop for Increasing Clinician Participation in the Design of Health Services Interventions: Participatory Design Approach. JMIR Hum Factors. 2022 Sep 22;9(3):e37313. doi: 10.2196/37313. PMID: 36136374; PMCID: PMC9539640.

Summary:
This study explored a web-based participatory design approach, called ECO-design, to conduct economical and efficient co-design workshops with primary care clinicians. The approach adapted traditional in-person co-design workshops to a 1-hour, web-based format, using videoconferencing and electronic materials to facilitate clinician participation. The workshops focused on co-developing feedback interventions for abnormal test result follow-up in primary care, including conversation guides, email templates, and dashboard prototypes. A total of 28 clinicians participated across four workshops, resulting in user interface prototypes and valuable insights for future workshop design. The findings suggest that ECO-design workshops are a feasible and cost-effective method for involving clinicians in healthcare intervention design, particularly during challenging times like the COVID-19 pandemic.

Citation:
Bradford A, Shofer M, Singh H. Measure Dx: Implementing pathways to discover and learn from diagnostic errors. Int J Qual Health Care. 2022 Sep 10;34(3):mzac068. doi: 10.1093/intqhc/mzac068. PMID: 36047352; PMCID: PMC9463874.

Summary:
This article presents Measure Dx, a framework designed to identify and learn from diagnostic errors in healthcare. The article emphasizes the importance of structured pathways for discovering diagnostic errors, analyzing their causes, and implementing lessons learned to improve patient safety. The authors discuss the practical application of this framework in healthcare organizations to foster a culture of continuous improvement and reduce diagnostic harm.

Citation:
Bradford A, Shahid U, Schiff GD, Graber ML, Marinez A, DiStabile P, Timashenka A, Jalal H, Brady PJ, Singh H. Development and Usability Testing of the Agency for Healthcare Research and Quality Common Formats to Capture Diagnostic Safety Events. J Patient Saf. 2022 Sep 1;18(6):521-525. doi: 10.1097/PTS.0000000000001006. Epub 2022 Apr 22. PMID: 35443253; PMCID: PMC9391254.

Summary:
This study developed and tested the usability of the Agency for Healthcare Research and Quality (AHRQ) Common Formats for capturing diagnostic safety events in healthcare settings. The study found that the formats were effective in identifying and documenting diagnostic errors, enhancing the ability to track and address safety concerns. Usability testing highlighted areas for improvement in data collection processes, aiming to streamline the reporting of diagnostic safety events across healthcare institutions.

Citation:
Zimolzak AJ, Singh H, Murphy DR, Wei L, Memon SA, Upadhyay DK, Korukonda S, Zubkoff L, Sittig DF. Translating electronic health record-based patient safety algorithms from research to clinical practice at multiple sites. BMJ Health Care Inform. 2022 Jul;29(1):e100565. doi: 10.1136/bmjhci-2022-100565. PMID: 35851287; PMCID: PMC9289019.

Summary:
This study examines the challenges and processes involved in translating electronic health record (EHR)-based patient safety algorithms from research settings into clinical practice across multiple healthcare sites. Additionally, the study highlights the barriers faced, such as variability in implementation and integration into existing workflows, but also emphasizes the potential for these algorithms to improve patient safety and reduce diagnostic errors. Their findings suggest that successful integration requires careful adaptation and support from clinical teams.

Citation:
Giardina TD, Choi DT, Upadhyay DK, Korukonda S, Scott TM, Spitzmueller C, Schuerch C, Torretti D, Singh H. Inviting patients to identify diagnostic concerns through structured evaluation of their online visit notes. J Am Med Inform Assoc. 2022 May 11;29(6):1091-1100. doi: 10.1093/jamia/ocac036. PMID: 35348688; PMCID: PMC9093029.

Summary:
This study explores the concept of inviting patients to identify diagnostic concerns by providing them access to structured evaluations of their online visit notes. The study found that this approach could improve patient engagement and enhance diagnostic accuracy by allowing patients to actively participate in the identification of potential issues or missed information. The findings suggest that involving patients in the diagnostic process may improve the overall quality of care and reduce diagnostic errors.

Citation:
Sittig DF, Lakhani P, Singh H. Applying requisite imagination to safeguard electronic health record transitions. J Am Med Inform Assoc. 2022 Apr 13;29(5):1014-1018. doi: 10.1093/jamia/ocab291. PMID: 35022741; PMCID: PMC9006683.

Summary:
This article emphasizes the need for innovative thinking in safeguarding the transitions between electronic health record (EHR) systems. The authors argue that while EHRs have transformed healthcare, their transitions can create risks, and creative solutions are essential to ensure patient safety and continuity of care during these transitions. The authors call for more focused attention on improving EHR changeovers to prevent errors and enhance healthcare quality.

Citation:
Ramesh S, Ayres B, Eyck PT, Dawson JD, Reisinger HS, Singh H, Herwaldt LA, Cifra CL. Impact of subspecialty consultations on diagnosis in the pediatric intensive care unit. Diagnosis (Berl). 2022 Apr 11;9(3):379-384. doi: 10.1515/dx-2021-0137. PMID: 35393849; PMCID: PMC9427695.

Summary:
This study examines the impact of subspecialty consultations on diagnostic accuracy in pediatric intensive care units (PICUs). The authors found that subspecialty consultations contributed to improved diagnosis in a significant number of cases, suggesting that expert input from specialists plays a critical role in enhancing diagnostic decision-making. The study highlights the value of interdisciplinary collaboration in complex pediatric cases to improve patient outcomes.

Citation:
Meyer AND, Scott TMT, Singh H. Adherence to National Guidelines for Timeliness of Test Results Communication to Patients in the Veterans Affairs Health Care System. JAMA Netw Open. 2022 Apr 1;5(4):e228568. doi: 10.1001/jamanetworkopen.2022.8568. PMID: 35452111; PMCID: PMC9034405.

Summary:
This study examines adherence to national guidelines for the timely communication of test results to patients within the Veterans Affairs Health Care System. The study finds that while most test results were communicated within the recommended timeframes, there were still significant delays in some cases. The authors highlight the need for improvements in the communication process to ensure timely and effective patient care.

Citation:
Cifra CL, Tigges CR, Miller SL, Curl N, Monson CD, Dukes KC, Reisinger HS, Pennathur PR, Sittig DF, Singh H. Reporting Outcomes of Pediatric Intensive Care Unit Patients to Referring Physicians via an Electronic Health Record-Based Feedback System. Appl Clin Inform. 2022 Mar;13(2):495-503. doi: 10.1055/s-0042-1748147. Epub 2022 May 11. PMID: 35545126; PMCID: PMC9095343.

Summary:
The study explores the development of an electronic health record-based feedback system to report the outcomes of pediatric intensive care unit (PICU) patients to referring physicians. The study demonstrated that providing timely and structured feedback via this system improved communication and helped referring physicians better understand patient outcomes. The authors suggest that this approach could enhance care coordination and decision-making across healthcare teams.

Citation:
Zimolzak AJ, Shahid U, Giardina TD, Memon SA, Mushtaq U, Zubkoff L, Murphy DR, Bradford A, Singh H. Why Test Results Are Still Getting "Lost" to Follow-up: a Qualitative Study of Implementation Gaps. J Gen Intern Med. 2022 Jan;37(1):137-144. doi: 10.1007/s11606-021-06772-y. Epub 2021 Apr 27. PMID: 33907982; PMCID: PMC8739406.

Summary:
This study explores the reasons behind the continued issue of "lost" test results in healthcare, focusing on implementation gaps in follow-up processes. Through qualitative research, the authors identify factors such as communication breakdowns, system inefficiencies, and lack of standardized procedures that contribute to delays or failure in managing test results. The study emphasizes the need for improvements in healthcare systems to ensure timely and effective follow-up, reducing patient safety risks.

Citation:
Giardina TD, Korukonda S, Shahid U, Vaghani V, Upadhyay DK, Burke GF, Singh H. Use of patient complaints to identify diagnosis-related safety concerns: a mixed-method evaluation. BMJ Qual Saf. 2021 Dec;30(12):996-1001. doi: 10.1136/bmjqs-2020-011593. Epub 2021 Feb 17. PMID: 33597282; PMCID: PMC8552507.

Summary:
This mixed-method evaluation explores the use of patient complaints as a tool to identify diagnosis-related safety concerns in healthcare. The study found that patient complaints often highlighted issues related to diagnostic errors, missed diagnoses, and delays in care. The authors suggest that analyzing these complaints can provide valuable insights into improving diagnostic safety and patient care quality.

Citation:
Cheraghi-Sohi S, Holland F, Singh H, Danczak A, Esmail A, Morris RL, Small N, Williams R, de Wet C, Campbell SM, Reeves D. Incidence, origins and avoidable harm of missed opportunities in diagnosis: longitudinal patient record review in 21 English general practices. BMJ Qual Saf. 2021 Dec;30(12):977-985. doi: 10.1136/bmjqs-2020-012594. Epub 2021 Jun 14. PMID: 34127547; PMCID: PMC8606447.

Summary:
This longitudinal patient record review of patient records across 21 English general practices was conducted to explore the incidence, origins, and avoidable harm of missed diagnostic opportunities. The study found that missed diagnoses were common, with multiple contributing factors, including issues with clinical processes and communication. The findings highlight significant opportunities for improving diagnostic safety to reduce harm in primary care settings.

Citation:
Zwaan L, El-Kareh R, Meyer AND, Hooftman J, Singh H. Advancing Diagnostic Safety Research: Results of a Systematic Research Priority Setting Exercise. J Gen Intern Med. 2021 Oct;36(10):2943-2951. doi: 10.1007/s11606-020-06428-3. Epub 2021 Feb 9. PMID: 33564945; PMCID: PMC8481519.

Summary:
This article explores a systematic research priority setting exercise to advance the field of diagnostic safety. The study identified key research priorities, including improving diagnostic accuracy, addressing cognitive biases, enhancing communication among healthcare teams, and focusing on healthcare system-level interventions. The authors emphasize the importance of prioritizing these areas to reduce diagnostic errors and improve patient outcomes.

Citation:
Murphy DR, Savoy A, Satterly T, Sittig DF, Singh H. Dashboards for visual display of patient safety data: a systematic review. BMJ Health Care Inform. 2021 Oct;28(1):e100437. doi: 10.1136/bmjhci-2021-100437. PMID: 34615664; PMCID: PMC8496385.

Summary:
This systematic review examines the effectiveness of dashboards for displaying patient safety data in healthcare settings. The review found that dashboards can enhance decision-making, improve clinical awareness, and support patient safety efforts by providing real-time data visualization. However, the authors highlight the need for further research to optimize their design and integration into clinical workflows.

Citation:
Daniel M, Park S, Seifert CM, Chandanabhumma PP, Fetters MD, Wilson E, Singh H, Pasupathy K, Mahajan P. Understanding diagnostic processes in emergency departments: a mixed methods case study protocol. BMJ Open. 2021 Sep 24;11(9):e044194. doi: 10.1136/bmjopen-2020-044194. PMID: 34561251; PMCID: PMC8475137.

Summary:
This article outlines a mixed-methods case study protocol to investigate diagnostic processes in emergency departments (EDs), focusing on how diagnoses are made, the challenges involved, and the factors contributing to diagnostic errors. The study aims to combine quantitative and qualitative data to provide a comprehensive understanding of diagnostic practices in EDs, with the goal of improving patient safety and reducing errors. The protocol includes interviews, observations, and data analysis to explore the complexities of diagnostic decision-making in high-pressure environments.

Citation:
Vaghani V, Wei L, Mushtaq U, Sittig DF, Bradford A, Singh H. Validation of an electronic trigger to measure missed diagnosis of stroke in emergency departments. J Am Med Inform Assoc. 2021 Sep 18;28(10):2202-2211. doi: 10.1093/jamia/ocab121. PMID: 34279630; PMCID: PMC8449630.

Summary:
This study validates an electronic trigger designed to detect missed diagnoses of stroke in emergency departments. The study found that the trigger accurately identified cases of missed stroke diagnoses providing a reliable tool for improving diagnostic safety. This validation highlights the potential of electronic triggers in enhancing early detection and reducing diagnostic errors in emergency care settings.

Citation:
Cifra CL, Custer JW, Singh H, Fackler JC. Diagnostic Errors in Pediatric Critical Care: A Systematic Review. Pediatr Crit Care Med. 2021 Aug 1;22(8):701-712. doi: 10.1097/PCC.0000000000002735. PMID: 33833203; PMCID: PMC8373621.

Summary:
This systematic review examines diagnostic errors in pediatric critical care, focusing on the types, causes, and consequences of errors in this high-risk environment. The review highlighted that diagnostic errors are a significant contributor to adverse outcomes in pediatric intensive care units, with factors such as communication breakdowns, incomplete information, and cognitive biases playing key roles. The authors emphasized the need for improved diagnostic processes and safety interventions to reduce these errors and enhance patient outcomes.

Citation:
Choi DT, Davila JA, Sansgiry S, David E, Singh H, El-Serag HB, Sada YH. Factors Associated With Delay of Diagnosis of Hepatocellular Carcinoma in Patients With Cirrhosis. Clin Gastroenterol Hepatol. 2021 Aug;19(8):1679-1687. doi: 10.1016/j.cgh.2020.07.026. Epub 2020 Jul 18. PMID: 32693047; PMCID: PMC7855025.

Summary:
This study explores the factors contributing to delayed diagnosis of hepatocellular carcinoma (HCC) in patients with cirrhosis. The study found that delays were associated with factors such as suboptimal surveillance, lack of timely imaging, and healthcare system challenges. The authors emphasized the importance of improving diagnostic processes and ensuring regular monitoring to reduce diagnostic delays and improve outcomes for these patients.

Citation:
Cifra CL, Sittig DF, Singh H. Bridging the feedback gap: a sociotechnical approach to informing clinicians of patients' subsequent clinical course and outcomes. BMJ Qual Saf. 2021 Jul;30(7):591-597. doi: 10.1136/bmjqs-2020-012464. Epub 2021 May 6. PMID: 33958442; PMCID: PMC8237185.

Summary:
This article examines the gap in feedback regarding patients' subsequent clinical course and outcomes, emphasizing the importance of timely and accurate information for clinicians. The study proposed a sociotechnical approach to improve feedback systems, integrating clinical data with decision support tools to enhance patient safety. This approach aims to reduce missed opportunities for improving care by informing clinicians of key patient developments after initial diagnoses or treatments.

Citation:
Enayati M, Sir M, Zhang X, Parker SJ, Duffy E, Singh H, Mahajan P, Pasupathy KS. Monitoring Diagnostic Safety Risks in Emergency Departments: Protocol for a Machine Learning Study. JMIR Res Protoc. 2021 Jun 14;10(6):e24642. doi: 10.2196/24642. PMID: 34125077; PMCID: PMC8240801.

Summary:
This article outlines a study protocol for using machine learning to monitor diagnostic safety risks in emergency departments. The study aims to develop predictive models to identify potential diagnostic errors by analyzing clinical data, ultimately improving patient safety. The authors focus on leveraging machine learning techniques to support real-time identification of diagnostic risks, enhancing clinical decision-making and reducing errors in emergency care.

Citation:
Cifra CL, Dukes KC, Ayres BS, Calomino KA, Herwaldt LA, Singh H, Reisinger HS. Referral communication for pediatric intensive care unit admission and the diagnosis of critically ill children: A pilot ethnography. J Crit Care. 2021 Jun;63:246-249. doi: 10.1016/j.jcrc.2020.09.011. Epub 2020 Sep 18. PMID: 32980235; PMCID: PMC7969466.

Summary:
This pilot ethnography explores referral communication during pediatric intensive care unit (PICU) admissions and its role in diagnosing critically ill children. The study highlighted the complexities and challenges in communication between healthcare providers during the referral process, which can impact the timely and accurate diagnosis of critically ill children. The findings underscore the need for improved communication strategies to enhance care transitions and patient outcomes in critical care settings.

Citation:
Dymek C, Kim B, Melton GB, Payne TH, Singh H, Hsiao CJ. Building the evidence-base to reduce electronic health record-related clinician burden. J Am Med Inform Assoc. 2021 Apr 23;28(5):1057-1061. doi: 10.1093/jamia/ocaa238. PMID: 33340326; PMCID: PMC8068419.

Summary:
This article discusses strategies for reducing clinician burden associated with electronic health records, highlighting the need for evidence-based approaches to improve efficiency and usability. They emphasize the importance of addressing issues such as excessive documentation, alert fatigue, and interface complexity, which contribute to clinician stress and burnout. The authors call for research to better understand these challenges and develop solutions that enhance both clinician well-being and patient care.

Citation:
Jones OT, Calanzani N, Saji S, Duffy SW, Emery J, Hamilton W, Singh H, de Wit NJ, Walter FM. Artificial Intelligence Techniques That May Be Applied to Primary Care Data to Facilitate Earlier Diagnosis of Cancer: Systematic Review. J Med Internet Res. 2021 Mar 3;23(3):e23483. doi: 10.2196/23483. PMID: 33656443; PMCID: PMC7970165.

Summary:
This systematic review explores the potential application of artificial intelligence (AI) techniques to primary care data for earlier cancer diagnosis. The study highlighted various AI methods, such as machine learning, which could improve the identification of cancer-related symptoms and risk factors in primary care settings. The authors suggest that these AI tools could enhance early detection and patient outcomes by providing timely and accurate insights.

Citation:
Singh H, Sittig DF, Gandhi TK. Fighting a common enemy: a catalyst to close intractable safety gaps. BMJ Qual Saf. 2021 Feb;30(2):141-145. doi: 10.1136/bmjqs-2020-011390. Epub 2020 Jul 16. PMID: 32675326; PMCID: PMC7841492.

Summary:
This article emphasizes the importance of addressing persistent safety gaps in healthcare by collaborating across disciplines to tackle common challenges. They argue that focusing on a unified goal, such as improving diagnostic safety, can serve as a catalyst for closing intractable gaps in patient safety. Overall, the article advocates for using a collective approach to create systemic changes and improve healthcare outcomes.

Citation:
Singh H, Carayon P. A Roadmap to Advance Patient Safety in Ambulatory Care. JAMA. 2020 Dec 22;324(24):2481-2482. doi: 10.1001/jama.2020.18551. PMID: 33351052; PMCID: PMC8016440.

Summary:
This article provides a roadmap to advance patient safety in ambulatory care settings, highlighting key areas for improvement such as enhancing communication, promoting a culture of safety, and integrating technology effectively. They emphasize the need for proactive identification of safety hazards, the use of data for continuous improvement, and fostering collaboration among healthcare teams. The authors call for a comprehensive approach to reduce errors and improve patient outcomes in outpatient settings.

Citation:
Mahajan P, Pai CW, Cosby KS, Mollen CJ, Shaw KN, Chamberlain JM, El-Kareh R, Ruddy RM, Alpern ER, Epstein HM, Giardina TD, Graber ML, Medford-Davis LN, Medlin RP, Upadhyay DK, Parker SJ, Singh H. Identifying trigger concepts to screen emergency department visits for diagnostic errors. Diagnosis (Berl). 2020 Nov 13;8(3):340-346. doi: 10.1515/dx-2020-0122. PMID: 33180032.

Summary:
This study identifies key trigger concepts to screen for diagnostic errors in emergency department (ED) visits. The study focused on developing a method to detect potential diagnostic mistakes by analyzing patient data and specific clinical indicators. This approach aims to improve diagnostic accuracy and reduce errors in fast-paced ED environments.

Citation:
Singh H, Upadhyay DK, Torretti D. Developing Health Care Organizations That Pursue Learning and Exploration of Diagnostic Excellence: An Action Plan. Acad Med. 2020 Aug;95(8):1172-1178. doi: 10.1097/ACM.0000000000003062. PMID: 31688035; PMCID: PMC7402609.

Summary:
This article explores the development of healthcare organizations focused on diagnostic excellence through continuous learning and exploration. They propose an action plan that includes fostering a culture of learning, improving diagnostic processes, and investing in educational resources to enhance diagnostic skills and reduce errors. The authors emphasize the importance of collaboration, leadership, and systematic efforts to achieve long-term improvements in diagnostic practices.

Citation:
Sittig DF, Singh H. COVID-19 and the Need for a National Health Information Technology Infrastructure. JAMA. 2020 Jun 16;323(23):2373-2374. doi: 10.1001/jama.2020.7239. PMID: 32421178.

Summary:
This article advocates for a robust national health information technology infrastructure in response to the COVID-19 pandemic. They argue that improving data interoperability, real-time information sharing, and the integration of electronic health records can enhance healthcare delivery, support decision-making, and improve patient outcomes during public health crises. The article calls for a comprehensive strategy to strengthen health IT systems to better prepare for future pandemics.

Citation:
Gandhi TK, Singh H. Reducing the Risk of Diagnostic Error in the COVID-19 Era. J Hosp Med. 2020 Jun;15(6):363-366. doi: 10.12788/jhm.3461. PMID: 32490798; PMCID: PMC7289509.

Summary:
This article discusses the increased risk of diagnostic errors during the COVID-19 pandemic due to factors like overwhelmed healthcare systems, resource limitations, and the complexity of diagnosing COVID-19-related conditions. They emphasize the importance of maintaining diagnostic vigilance, improving communication among healthcare teams, and utilizing technology to support diagnostic decision-making. The article provides recommendations for healthcare organizations to mitigate diagnostic errors and improve patient safety during the pandemic.

Citation:
Meyer AND, Giardina TD, Spitzmueller C, Shahid U, Scott TMT, Singh H. Patient Perspectives on the Usefulness of an Artificial Intelligence-Assisted Symptom Checker: Cross-Sectional Survey Study. J Med Internet Res. 2020 Jan 30;22(1):e14679. doi: 10.2196/14679. PMID: 32012052; PMCID: PMC7055765.

Summary:
This study explores the use of a cross-sectional survey to assess patient perspectives on the usefulness of an artificial intelligence-assisted symptom checker. The study found that while patients generally expressed interest in using the tool, they had concerns about its accuracy and the lack of personalized medical advice. Overall, the findings suggest that while patients are open to AI-driven symptom checkers, they prioritize trust, clarity, and the integration of professional medical input.