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Search All Research Studies
AHRQ Research Studies Date
Topics
- Adverse Drug Events (ADE) (1)
- (-) Adverse Events (9)
- Cardiovascular Conditions (1)
- Children/Adolescents (2)
- Diagnostic Safety and Quality (3)
- Elderly (1)
- (-) Emergency Department (9)
- Healthcare Cost and Utilization Project (HCUP) (1)
- Hospitalization (1)
- Long-Term Care (1)
- Medical Errors (3)
- Medication (1)
- Opioids (1)
- Patient Safety (4)
- Practice Patterns (1)
- Stroke (1)
AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 9 of 9 Research Studies DisplayedMahajan P, Mollen C, Alpern ER
An operational framework to study diagnostic errors in emergency departments: findings from a consensus panel.
The purpose of this study was to create an operational definition and framework to study diagnostic error in the emergency department setting. A multidisciplinary panel defined diagnostic errors, modified the National Academies of Sciences, Engineering, and Medicine's diagnostic process framework, and underscored the importance of outcome feedback to emergency department providers to promote learning and improvement related to diagnosis.
AHRQ-funded; HS024953.
Citation: Mahajan P, Mollen C, Alpern ER .
An operational framework to study diagnostic errors in emergency departments: findings from a consensus panel.
J Patient Saf 2021 Dec 1;17(8):570-75. doi: 10.1097/pts.0000000000000624..
Keywords: Diagnostic Safety and Quality, Emergency Department, Medical Errors, Adverse Events
Griffey RT, Schneider RM, Sharp BR
Multicenter test of an emergency department trigger tool for detecting adverse events.
This study details a novel emergency department (ED) trigger tool to detect adverse events using a multidisciplinary, multicenter approach developed by the authors. They conducted a multicenter test of the tool and assessed its performance. The study was conducted during a 13-month period at 4 EDs. Patients age 18 years and older with Emergency Severity Index acuity levels of 1 to 3 by a provider were eligible. Fifty randomly selected visits at each site were reviewed a month. Events were classified by level of harm using the Medication Event Reporting and Prevention (MERP) Index, ranging from a near miss (A) to patient death (I). They captured 2594 visits that are representative, within site, of their patient population. Overall, the sample is 64% white, 54% female, and with a mean age of 51. Variability was observed between sites for age, race, and insurance, but not sex. A total of 240 events were identified in 228 visits (8.8%) of which 53.3% were present on arrival, 19.7% were acts of omission, and 44.6% were medication related. A MERP F score (contributing to need for admission, higher level of care, or prolonged hospitalization) was the most common severity level at 35.4%. Overall, 185 (77.1%) of 240 events involved patient harm (MERP level ≥ E), affecting 175 visits (6.7%). Triggers were present in 951 visits (36.6%). Presence of any trigger was strongly associated with an AE. Ten triggers were individually associated with AEs. Variability was observed across sites in individual trigger associations, event rates, and categories, but not in severity ratings of events. The overall false-negative rate was 6.1%.
AHRQ-funded; HS025052.
Citation: Griffey RT, Schneider RM, Sharp BR .
Multicenter test of an emergency department trigger tool for detecting adverse events.
J Patient Saf 2021 Dec 1;17(8):e843-e49. doi: 10.1097/pts.0000000000000516..
Keywords: Emergency Department, Adverse Events, Patient Safety
Griffey RT, Schneider RM, Sharp BR
Practical considerations in use of trigger tool methodology in the emergency department.
This article’s purpose was to provide general observations, guidance, and lessons learned in the use of a trigger tool in the emergency department (ED) for adverse events (AEs). The authors identified 46 triggers in the initial ED trigger tool. They tried to include triggers of various types to capture events related to different aspects of an ED visit. The trigger events were reviewed by first-level reviewers, who are typically nurses, and then by second-level reviewers, who are usually other clinicians. An AE was identified using the AHRQ definition adopted by the IHI GTT, which is limited to physical (but not emotional or mental) harm. It must be unintentional and attributable to healthcare. Acts of omission must be included not just acts of commission. They used a modified National Coordinating Council’s Medication Event Reporting and Prevention (MERP) Index to assess severity of harm. MERP E-I events are identified as those that had interventions, with MERP A-D events noted. They outlined several salient areas for consideration in implementing a trigger tool in the ED setting and also specified how to address the highlighted issues.
AHRQ-funded; HS025052.
Citation: Griffey RT, Schneider RM, Sharp BR .
Practical considerations in use of trigger tool methodology in the emergency department.
J Patient Saf 2021 Dec 1;17(8):e837-e42. doi: 10.1097/pts.0000000000000448..
Keywords: Emergency Department, Adverse Events, Patient Safety
Vaghani V, Wei L, U
Validation of an electronic trigger to measure missed diagnosis of stroke in emergency departments.
Diagnostic errors are major contributors to preventable patient harm. In this study, the investigators validated the use of an electronic health record (EHR)-based trigger (e-trigger) to measure missed opportunities in stroke diagnosis in emergency departments (EDs). The investigators concluded that a symptom-disease pair-based e-trigger identified missed diagnoses of stroke with a modest positive predictive value, underscoring the need for chart review validation procedures to identify diagnostic errors in large data sets.
AHRQ-funded; HS017820; HS024459.
Citation: Vaghani V, Wei L, U .
Validation of an electronic trigger to measure missed diagnosis of stroke in emergency departments.
J Am Med Inform Assoc 2021 Sep 18;28(10):2202-11. doi: 10.1093/jamia/ocab121..
Keywords: Stroke, Cardiovascular Conditions, Emergency Department, Diagnostic Safety and Quality, Medical Errors, Adverse Events
Mahajan P, Pai CW, Cosby KS
Identifying trigger concepts to screen emergency department visits for diagnostic errors.
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. In this study, the investigators 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.
AHRQ-funded; HS024953; HS027363.
Citation: Mahajan P, Pai CW, Cosby KS .
Identifying trigger concepts to screen emergency department visits for diagnostic errors.
Diagnosis 2021 Aug 26;8(3):340-46. doi: 10.1515/dx-2020-0122..
Keywords: Emergency Department, Diagnostic Safety and Quality, Medical Errors, Adverse Events, Patient Safety
Lord K, Rothenberg C, Parwani V
Association between emergency department chief complaint and adverse hospitalization outcomes: a simple early warning system?
Researchers sought to examine the association between the emergency department chief complaint and specific adverse outcomes after admission to a general medicine floor. They found that chief complaint may be an early identifier of those patients uniquely at risk for adverse hospitalization outcomes. Patients presenting with seizure, leg swelling, and shortness of breath who were subsequently admitted to a general medical floor were more likely to suffer care escalations, Rapid Response Team activation, or mortality. Conversely, patients with chief complaints of loss of consciousness, headache, and chest pain were at low risk of adverse outcomes.
AHRQ-funded; HS023554.
Citation: Lord K, Rothenberg C, Parwani V .
Association between emergency department chief complaint and adverse hospitalization outcomes: a simple early warning system?
Am J Emerg Med 2021 Jul;45:548-50. doi: 10.1016/j.ajem.2020.07.040..
Keywords: Emergency Department, Hospitalization, Adverse Events
Worsham CM, Woo J, Jena AB
Adverse events and emergency department opioid prescriptions in adolescents.
Understanding the risks associated with opioid prescription in adolescents is critical for informing opioid policy, but the risks are challenging to quantify given the lack of randomized trial data. Using a regression discontinuity design, the investigators exploited a discontinuous increase in opioid prescribing in the emergency department (ED) when adolescents transitioned from "child" to "adult" at age eighteen to estimate the effect of an ED opioid prescription on subsequent opioid-related adverse events.
AHRQ-funded; HS026753.
Citation: Worsham CM, Woo J, Jena AB .
Adverse events and emergency department opioid prescriptions in adolescents.
Health Aff 2021 Jun;40(6):970-78. doi: 10.1377/hlthaff.2020.01762..
Keywords: Children/Adolescents, Emergency Department, Opioids, Medication, Adverse Drug Events (ADE), Adverse Events, Patient Safety, Practice Patterns
Michelson KA, Dart AH, Bachur RG
Measuring complications of serious pediatric emergencies using ICD-10.
The purpose of this study was to create definitions for complications for 16 serious pediatric conditions using the International Classification of Diseases, 10th Revision, Clinical Modification or Procedure Coding System (ICD-10-CM/PCS), and to assess whether complication rates are similar to those measured with ICD-9-CM/PCS. The investigators concluded that for most conditions, incidences and complication rates were similar before and after the transition to ICD-10-CM/PCS codes, suggesting their system identified complications of conditions in administrative data similarly using ICD-9-CM/PCS and ICD-10-CM/PCS codes.
AHRQ-funded; HS026503.
Citation: Michelson KA, Dart AH, Bachur RG .
Measuring complications of serious pediatric emergencies using ICD-10.
Health Serv Res 2021 Apr;56(2):225-34. doi: 10.1111/1475-6773.13615..
Keywords: Healthcare Cost and Utilization Project (HCUP), Children/Adolescents, Emergency Department, Adverse Events
Griffey RT, Schneider RM, Adler L
Post-acute and long-term care patients account for a disproportionately high number of adverse events in the emergency department.
This retrospective observation study compares emergency department (ED) rates for adverse events (AEs) between post-acute and long-term care settings (PA/LTC) residents and non-PA/LTC residents. The authors describe all-cause harm among patients from PA/LTC setting seen in the ED. The study used the ED Trigger Tool, with dual independent nurse reviews of 5582 ED records with triggers. Data was captured for all adult patients at an urban, academic ED over a 13-month period. PA/LTC patients tended to be older (median 69 vs 50 years old). They accounted for 21% of all AEs (26% present on arrival, 13% in ED). Present on arrival AEs from a PA/LTC setting were most commonly patient-care related (39%), medication (34%) and infections (16%). The analysis showed that a disproportionate number of ED visits from PA/LTC are for AEs, which is an admission rate double that for non-PA/LTC patients.
AHRQ-funded; R18 HS025052.
Citation: Griffey RT, Schneider RM, Adler L .
Post-acute and long-term care patients account for a disproportionately high number of adverse events in the emergency department.
J Am Med Dir Assoc 2021 Apr;22(4):907-12.e1. doi: 10.1016/j.jamda.2020.06.043..
Keywords: Elderly, Long-Term Care, Emergency Department, Adverse Events