National Healthcare Quality and Disparities Report
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Topics
- Adverse Drug Events (ADE) (2)
- Adverse Events (7)
- Alcohol Use (2)
- Asthma (2)
- Autism (1)
- Behavioral Health (4)
- Blood Pressure (4)
- Cancer (13)
- Cancer: Breast Cancer (2)
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- Children/Adolescents (9)
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- Communication (2)
- Comparative Effectiveness (1)
- Critical Care (1)
- Cultural Competence (1)
- Dementia (1)
- Depression (2)
- Diabetes (1)
- (-) Diagnostic Safety and Quality (65)
- Digestive Disease and Health (1)
- Education: Academic (1)
- Education: Continuing Medical Education (1)
- Education: Patient and Caregiver (1)
- Elderly (3)
- Electronic Health Records (EHRs) (9)
- Emergency Department (5)
- Emergency Medical Services (EMS) (2)
- Evidence-Based Practice (1)
- Genetics (2)
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- Healthcare Cost and Utilization Project (HCUP) (3)
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- Heart Disease and Health (3)
- Human Immunodeficiency Virus (HIV) (2)
- Imaging (9)
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- Intensive Care Unit (ICU) (2)
- Kidney Disease and Health (1)
- Long-Term Care (1)
- Medical Errors (9)
- Medicare (2)
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- Medication: Safety (1)
- Neonatal Intensive Care Unit (NICU) (1)
- Neurological Disorders (1)
- Newborns/Infants (3)
- Nursing Homes (1)
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- Patient-Centered Healthcare (1)
- Patient-Centered Outcomes Research (3)
- Patient and Family Engagement (1)
- Patient Experience (3)
- Patient Safety (9)
- Payment (1)
- Practice Patterns (1)
- Prevention (4)
- Primary Care (1)
- Quality Improvement (2)
- Quality of Care (4)
- Research Methodologies (2)
- Respiratory Conditions (2)
- Risk (1)
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- Sepsis (2)
- Shared Decision Making (5)
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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 25 of 65 Research Studies DisplayedDombrowsky A, Borg B, Xie R
Why is hyperparathyroidism underdiagnosed and undertreated in older adults?
The purpose of this study was to determine why older patients with hyperparathyroidism were not appropriately diagnosed and referred for parathyroidectomy. They reviewed charts for a random sample of 25 patients aged 75 and older who had hyperparathyroidism and were referred for surgical evaluation, and 25 who were not referred. The investigators concluded that substantial gaps existed in processes for diagnosis and referral of patients with hyperparathyroidism that led to underdiagnosis and undertreatment.
AHRQ-funded; HS023009.
Citation: Dombrowsky A, Borg B, Xie R .
Why is hyperparathyroidism underdiagnosed and undertreated in older adults?
Clin Med Insights Endocrinol Diabetes 2018 Dec 12;11:1179551418815916. doi: 10.1177/1179551418815916..
Keywords: Diagnostic Safety and Quality, Elderly
Medford-Davis LN, Singh H, Mahajan P
Diagnostic decision-making in the emergency department.
Emergency providers must often diagnose from undifferentiated symptoms, without previous knowledge of the patient. Failure to provide an accurate assessment of the problem or to communicate the problem to the patient is diagnostic error. This article considers methods to monitor diagnostic error in emergency departments.
AHRQ-funded; HS024953.
Citation: Medford-Davis LN, Singh H, Mahajan P .
Diagnostic decision-making in the emergency department.
Pediatr Clin North Am 2018 Dec;65(6):1097-105. doi: 10.1016/j.pcl.2018.07.003..
Keywords: Emergency Department, Diagnostic Safety and Quality, Shared Decision Making, Medical Errors, Patient Safety
Lacson R, Laroya R, Wang A
Integrity of clinical information in computerized order requisitions for diagnostic imaging.
This study compared the integrity of electronic health record (EHR) imaging order requisitions with EHR provider notes and their potential impact on order inaccuracies and interpretation of results. This retrospective study was conducted at a tertiary academic medical center using MRI lumbar spine and CT abdomen/pelvis orders performed from April 1 to May 31, 2016. Results showed that requisition indications were more likely to be incomplete than provider notes. Researchers recommended that relevant documentation be more readily available in EHRs.
Citation: Lacson R, Laroya R, Wang A .
Integrity of clinical information in computerized order requisitions for diagnostic imaging.
J Am Med Inform Assoc 2018 Dec;25(12):1651-56. doi: 10.1093/jamia/ocy133..
Keywords: Diagnostic Safety and Quality, Electronic Health Records (EHRs), Health Information Technology (HIT), Imaging
Grover S, Desir F, Jing Y
Reduced cancer survival among adults with HIV and AIDS-defining illnesses despite no difference in cancer stage at diagnosis.
A cohort of persons with HIV (PWH) who had AIDS-defining illness (ADI) at the time of cancer diagnosis were compared to those without HIV and ADI with cancer diagnosis at the same stages. Those with ADI had a higher mortality rate (30-70%) with lung cancer statistically significant. This finding is related with HIV-related immune suppression.
AHRQ-funded; 90047713.
Citation: Grover S, Desir F, Jing Y .
Reduced cancer survival among adults with HIV and AIDS-defining illnesses despite no difference in cancer stage at diagnosis.
J Acquir Immune Defic Syndr 2018 Dec 1;79(4):421-29. doi: 10.1097/qai.0000000000001842..
Keywords: Cancer, Diagnostic Safety and Quality, Human Immunodeficiency Virus (HIV), Outcomes
Heslin KC, Barrett ML
AHRQ Author: Heslin KC
Shifts in alcohol-related diagnoses after the introduction of International Classification of Diseases, Tenth Revision, clinical modification coding in U.S. hospitals: implications for epidemiologic research.
This study examined the impact of the ICD-10-CM coding system on estimates of hospital stays involving alcohol-related diagnoses. Using 2014 to 2017 HCUP data, results indicated that, on average, the number of stays involving any alcohol-related diagnosis in the 6 quarters before and after the ICD-10-CM transition was stable. However, substantial shifts in stays occurred for alcohol abuse, alcohol-induced mental disorders, and intoxication or toxic effects. Researchers conducting trend analyses of inpatient stays involving alcohol-related diagnoses should consider how ongoing modifications in the ICD-10-CM code system and coding guidelines might affect their work.
AHRQ-authored; AHRQ-funded.
Citation: Heslin KC, Barrett ML .
Shifts in alcohol-related diagnoses after the introduction of International Classification of Diseases, Tenth Revision, clinical modification coding in U.S. hospitals: implications for epidemiologic research.
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Keywords: Healthcare Cost and Utilization Project (HCUP), Alcohol Use, Diagnostic Safety and Quality, Substance Abuse
Shaker M, Verma K, Greenhawt M
The health and economic outcomes of early egg introduction strategies.
This study compared the costs and benefits of early egg introduction (EEI) using simulation and Markov modeling over a 20-year horizon with data from the United States, Europe, and Canada. Per child it was more expensive to provide early screening for all children with early-onset eczema than to have a “wait and see” approach. While there would be more egg allergy diagnosis with early screening, the increased costs were too great compared to the no-screening approach.
Citation: Shaker M, Verma K, Greenhawt M .
The health and economic outcomes of early egg introduction strategies.
Allergy 2018 Nov;73(11):2214-23. doi: 10.1111/all.13565..
Keywords: Children/Adolescents, Screening, Healthcare Costs, Diagnostic Safety and Quality, Medication
Cochon L, Lacson R, Wang A
Assessing information sources to elucidate diagnostic process errors in radiologic imaging - a human factors framework.
The purpose of this study was to assess information sources that may elucidate errors related to radiologic diagnostic imaging, quantify the incidence of potential safety events from each source, and quantify the number of steps involved from diagnostic imaging chain and socio-technical factors. Information sources can elucidate errors in various steps within the diagnostic imaging workflow and can provide insight into socio-technical factors that impact patient safety in the diagnostic process.
AHRQ-funded; HS024722.
Citation: Cochon L, Lacson R, Wang A .
Assessing information sources to elucidate diagnostic process errors in radiologic imaging - a human factors framework.
J Am Med Inform Assoc 2018 Nov;25(11):1507-15. doi: 10.1093/jamia/ocy103..
Keywords: Diagnostic Safety and Quality, Imaging, Medical Errors, Patient Safety
Anstey DE, Muntner P, Bello NA
Diagnosing masked hypertension using ambulatory blood pressure monitoring, home blood pressure monitoring, or both?
The aim of this study was to determine the overlap between ambulatory blood pressure monitoring (ABPM) and home blood pressure monitoring (HBPM) for the detection of masked hypertension (MHT). The investigators asserted that their data suggested that conducting ABPM will detect many individuals with MHT who have an increased cardiovascular disease risk.
AHRQ-funded; HS024262.
Citation: Anstey DE, Muntner P, Bello NA .
Diagnosing masked hypertension using ambulatory blood pressure monitoring, home blood pressure monitoring, or both?
Hypertension 2018 Nov;72(5):1200-07. doi: 10.1161/hypertensionaha.118.11319..
Keywords: Blood Pressure, Diagnostic Safety and Quality
Giardina TD, Haskell H, Menon S
Learning from patients' experiences related to diagnostic errors is essential for progress in patient safety.
Diagnostic error research has largely focused on individual clinicians' decision making and system design, while overlooking information from patients. In this paper, the authors analyzed patient- and family-reported error narratives to explore factors that contribute to diagnostic errors. The authors suggest that health systems should develop and implement formal programs to collect patients' experiences with the diagnostic process and use these data to promote an organizational culture that strives to reduce harm from diagnostic error.
AHRQ-funded; HS022087; HS017820; HS023558.
Citation: Giardina TD, Haskell H, Menon S .
Learning from patients' experiences related to diagnostic errors is essential for progress in patient safety.
Health Aff 2018 Nov;37(11):1821-27. doi: 10.1377/hlthaff.2018.0698..
Keywords: Diagnostic Safety and Quality, Patient Experience, Patient Safety, Quality Improvement
Berenson R, Singh H
Payment innovations to improve diagnostic accuracy and reduce diagnostic error.
Researchers examined ways that payment innovations could be used to improve diagnostic accuracy and reduce diagnostic error among Medicare patients. They recommended three different approaches: 1) coding changes in the Medicare Physician Fee schedule; new Alternative Payment Models (APMs) that could improve accuracy in challenging cases and even provide second or third opinions; and 3) have a method that accurate diagnoses would trigger APM payments and establish payment amounts.
AHRQ-funded; HS022087; HS017820.
Citation: Berenson R, Singh H .
Payment innovations to improve diagnostic accuracy and reduce diagnostic error.
Health Aff 2018 Nov;37(11):1828-35. doi: 10.1377/hlthaff.2018.0714..
Keywords: Diagnostic Safety and Quality, Payment, Medical Errors, Medicare, Patient Safety, Quality of Care
Albrecht JS, Hanna M, Kim D
Predicting diagnosis of Alzheimer's disease and related dementias using administrative claims.
The objective of this study is to see if a better predictive model could be created for earlier diagnosis of Alzheimer disease and related dementia (ADRD) using the amount of health care utilization (HCU) in individuals prior to diagnosis. A case-control study was conducted including individuals with and without mild cognitive impairment who were diagnosed between 2011 and 2014. They were matched to controls without ADRD and were able to obtain moderate accuracy.
AHRQ-funded; HS024560.
Citation: Albrecht JS, Hanna M, Kim D .
Predicting diagnosis of Alzheimer's disease and related dementias using administrative claims.
J Manag Care Spec Pharm 2018 Nov;24(11):1138-45. doi: 10.18553/jmcp.2018.24.11.1138..
Keywords: Dementia, Diagnostic Safety and Quality, Neurological Disorders
Heslin KC, Barrett ML
AHRQ Author: Heslin KC
Shifts in alcohol-related diagnoses after the introduction of International Classification of Diseases, Tenth Revision, clinical modification coding in U.S. hospitals: implications for epidemiologic research.
This study examined the impact of the ICD-10-CM coding system on estimates of hospital stays involving alcohol-related diagnoses. This analysis used 2014 to 2017 administrative data from the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project State Inpatient Databases for 17 states. The investigators found that on average, the number of stays involving any alcohol-related diagnosis in the 6 quarters before and after the ICD-10-CM transition was stable. However, substantial shifts in stays occurred for alcohol abuse, alcohol-induced mental disorders, and intoxication or toxic effects.
AHRQ-authored.
Citation: Heslin KC, Barrett ML .
Shifts in alcohol-related diagnoses after the introduction of International Classification of Diseases, Tenth Revision, clinical modification coding in U.S. hospitals: implications for epidemiologic research.
Alcohol Clin Exp Res 2018 Nov;42(11):2205-13. doi: 10.1111/acer.13866..
Keywords: Alcohol Use, Diagnostic Safety and Quality, Healthcare Cost and Utilization Project (HCUP), Substance Abuse
Bates DW, Singh H
Two decades since To Err Is Human: an assessment of progress and emerging priorities in patient safety.
This paper comments on the progress made in improving patient safety since the 1999 report from The Institute of Medicine titled “To Err is Human” was published. This landmark report highlighted problem areas, and since then there has been a number of effective interventions to prevent hospital-acquired infections and improve medication safety. Additional areas for improvement have also been identified in the past two decades, including outpatient care, diagnostic, errors and the use of health information technology. The authors believe that electronic data developments can help increase patient safety even further.
AHRQ-funded; HS022087; HS017820.
Citation: Bates DW, Singh H .
Two decades since To Err Is Human: an assessment of progress and emerging priorities in patient safety.
Health Aff 2018 Nov;37(11):1736-43. doi: 10.1377/hlthaff.2018.0738..
Keywords: Adverse Drug Events (ADE), Adverse Events, Diagnostic Safety and Quality, Electronic Health Records (EHRs), Health Information Technology (HIT), Medical Errors, Medication, Medication: Safety, Patient Safety, Prevention
Gadhoumi K, Do D, Badilini F
Wavelet leader multifractal analysis of heart rate variability in atrial fibrillation.
Accurate and timely detection of atrial fibrillation (AF) episodes is important in primary and secondary prevention of ischemic stroke and heart-related problems. In this work, heart rate regularity of ECG inter-beat intervals was investigated in episodes of AF and other rhythms using a wavelet leader based multifractal analysis. The investigators’ aim was to improve the detectability of AF episodes.
AHRQ-funded; HS022860.
Citation: Gadhoumi K, Do D, Badilini F .
Wavelet leader multifractal analysis of heart rate variability in atrial fibrillation.
J Electrocardiol 2018 Nov - Dec;51(6s):S83-s87. doi: 10.1016/j.jelectrocard.2018.08.030..
Keywords: Heart Disease and Health, Diagnostic Safety and Quality, Cardiovascular Conditions
Chopra V, Harrod M, Winter S
Focused ethnography of diagnosis in academic medical centers.
J Hosp Med 2018 Oct;13(10):668-72. doi: 10.12788/jhm.2966.
This ethnographic study focused on the progress of teaching diagnosis to trainees in academic teaching hospitals. Trainees at 2 academic medical centers were observed to understand the barriers and facilitators to diagnosis. A total of 4 teaching teams between January and May 2016 were observed. Four key themes were identified and can be used to inform future interventions.
This ethnographic study focused on the progress of teaching diagnosis to trainees in academic teaching hospitals. Trainees at 2 academic medical centers were observed to understand the barriers and facilitators to diagnosis. A total of 4 teaching teams between January and May 2016 were observed. Four key themes were identified and can be used to inform future interventions.
AHRQ-funded; HS024385; HS022835.
Citation: Chopra V, Harrod M, Winter S .
Focused ethnography of diagnosis in academic medical centers.
J Hosp Med 2018 Oct;13(10):668-72. doi: 10.12788/jhm.2966..
Keywords: Education: Continuing Medical Education, Education: Academic, Diagnostic Safety and Quality, Cultural Competence
Pouppirt NR, Nassar R, Napolitano N
Association between video laryngoscopy and adverse tracheal intubation-associated events in the neonatal intensive care unit.
The purpose of this single-site retrospective cohort study was to consider the possible effect of video laryngoscopy on adverse events during neonatal tracheal intubation. The researchers conclude that video laryngoscopy was independently associated with decreased risk for adverse events.
AHRQ-funded; HS022464; HS024511.
Citation: Pouppirt NR, Nassar R, Napolitano N .
Association between video laryngoscopy and adverse tracheal intubation-associated events in the neonatal intensive care unit.
J Pediatr 2018 Oct;201:281-84.e1. doi: 10.1016/j.jpeds.2018.05.046..
Keywords: Adverse Events, Diagnostic Safety and Quality, Neonatal Intensive Care Unit (NICU), Newborns/Infants, Patient Safety
Symer MM, Yeo HL
Recent advances in the management of anal cancer.
The incidence of anal cancer is gradually increasing. This article discusses the epidemiology and pathogenesis of anal cancer, and the prevention of human papilloma virus (HPV) infection as an important management principle. Screening recommendations from various sources are reviewed, and the authors note that screening for individuals at risk of anal cancer should include anal cytology and anoscopy. Current treatments and special cases are also reviewed; the authors conclude that treatments such biological therapies, therapeutic vaccination, and immunotherapy are likely to improve outcomes in patients with anal cancer.
AHRQ-funded; HS000066.
Citation: Symer MM, Yeo HL .
Recent advances in the management of anal cancer.
F1000Res 2018 Sep 28;7. doi: 10.12688/f1000research.14518.1..
Keywords: Cancer, Care Management, Diagnostic Safety and Quality, Screening
Millenson ML, Baldwin JL, Zipperer L
Beyond Dr. Google: the evidence on consumer-facing digital tools for diagnosis.
Direct-to-consumer (DTC), interactive, diagnostic apps with information personalization capabilities beyond those of static search engines are rapidly proliferating. Little is known about the state of the evidence on the performance of these apps or the methods used to evaluate them. In this paper, the authors conducted a scoping review of the peer-reviewed and gray literature for the period January 1, 2014-June 30, 2017 to examine the current evidence base on DTC, interactive diagnostic apps.
AHRQ-funded; HS022087.
Citation: Millenson ML, Baldwin JL, Zipperer L .
Beyond Dr. Google: the evidence on consumer-facing digital tools for diagnosis.
Diagnosis 2018 Sep 25;5(3):95-105. doi: 10.1515/dx-2018-0009..
Keywords: Diagnostic Safety and Quality, Education: Patient and Caregiver, Health Information Technology (HIT), Web-Based
Gupta A, Harrod M, Quinn M
Mind the overlap: how system problems contribute to cognitive failure and diagnostic errors.
This study focused on how system problems within two academic institutions contribute to cognitive and diagnostic errors of inpatient physicians. Observations were conducted by physicians, nurses, and non-clinicians (qualitative researchers, social scientists and health care engineers). Focus groups were also conducted. System-based problems included interruptions, time constraints and physical space.
AHRQ-funded; HS024385; HS022835; HS022087.
Citation: Gupta A, Harrod M, Quinn M .
Mind the overlap: how system problems contribute to cognitive failure and diagnostic errors.
Diagnosis 2018 Sep 25;5(3):151-56. doi: 10.1515/dx-2018-0014..
Keywords: Diagnostic Safety and Quality, Quality of Care, Healthcare Delivery, Inpatient Care, Medical Errors
Rao G, Naureckas S, Datta A
Pediatric hypertension: diagnostic patterns derived from electronic health records.
This study examined the rates of diagnostic for pediatric hypertension using electronic health records (EHRs). The rates of diagnosis were very low (6.1%) among 1478 children identified as hypertensive. Rates of diagnosis improved in children aged 12 and above but was very low for children aged 6 and under. Underdiagnosis can lead to organ failure and increased risk for adult hypertension.
AHRQ-funded; HS024100.
Citation: Rao G, Naureckas S, Datta A .
Pediatric hypertension: diagnostic patterns derived from electronic health records.
Diagnosis 2018 Sep;5(3):157-60. doi: 10.1515/dx-2018-0010..
Keywords: Children/Adolescents, Blood Pressure, Diagnostic Safety and Quality, Electronic Health Records (EHRs), Health Information Technology (HIT)
Koziatek CA, Simon E, Horwitz LI
Automated pulmonary embolism risk classification and guideline adherence for computed tomography pulmonary angiography ordering.
The objective of this study was to measure the performance of automated, structured data-only versions of the Wells and revised Geneva risk scores in emergency department encounters during which a computed tomography pulmonary angiography was ordered. The hypothesis was that such an automated method would classify a patient's pulmonary embolism risk with high accuracy compared to manual chart review.
AHRQ-funded; HS024376.
Citation: Koziatek CA, Simon E, Horwitz LI .
Automated pulmonary embolism risk classification and guideline adherence for computed tomography pulmonary angiography ordering.
Acad Emerg Med 2018 Sep;25(9):1053-61. doi: 10.1111/acem.13442..
Keywords: Respiratory Conditions, Risk, Diagnostic Safety and Quality, Emergency Department, Imaging, Guidelines
Gyftopoulos S, Smith SW, Simon E
Qualitative study to understand ordering of CT angiography to diagnose pulmonary embolism in the emergency room setting.
The purpose of the study was to better understand, using semi-structured interviews, the decision making behind the ordering of CT pulmonary angiography (CTPA) for the diagnosis of pulmonary embolism (PE) in the emergency department. The authors found that EM providers were the main drivers of CTPA ordering, and there was a marginalized role for the radiologist. Experience- and gestalt-based heuristics were the main influencers of CTPA ordering.
AHRQ-funded; HS024376.
Citation: Gyftopoulos S, Smith SW, Simon E .
Qualitative study to understand ordering of CT angiography to diagnose pulmonary embolism in the emergency room setting.
J Am Coll Radiol 2018 Sep;15(9):1276-84. doi: 10.1016/j.jacr.2017.08.022..
Keywords: Diagnostic Safety and Quality, Emergency Department, Emergency Medical Services (EMS), Imaging
Shaker M, Stukus D, Chan ES
"To screen or not to screen": comparing the health and economic benefits of early peanut introduction strategies in five countries.
This study compared the costs and benefits of early peanut introduction (EPI) using data from five countries: US, Canada, Australia, New Zealand and United Kingdom. Per child it was more expensive to provide early screening for all children with early-onset eczema and/or egg allergy than to have a “wait and see” approach. While there would be more peanut allergy diagnosis with early screening, the increased costs were too great compared to the no-screening approach.
AHRQ-funded; HS024599.
Citation: Shaker M, Stukus D, Chan ES .
"To screen or not to screen": comparing the health and economic benefits of early peanut introduction strategies in five countries.
Allergy 2018 Aug;73(8):1707-14. doi: 10.1111/all.13446..
Keywords: Children/Adolescents, Screening, Diagnostic Safety and Quality, Healthcare Costs, Medication, Medication
Shetterly Shetterly, S Flory, J
Diagnosis-based cohort augmentation using laboratory results data: the case of chronic kidney disease.
This study used data from FDA’s Sentinel System to determine if augmenting a diagnosis-based chronic kidney disease cohort with patients identified through laboratory results impacted cohort characteristics and outcomes. They divided the cohort into three different groups to compare demographic, clinical, and health care utilization characteristics. They observed mortality rates between the different groups.
AHRQ-funded; HS023898.
Citation: Shetterly Shetterly, S Flory, J .
Diagnosis-based cohort augmentation using laboratory results data: the case of chronic kidney disease.
Pharmacoepidemiol Drug Saf 2018 Aug;27(8):872-77. doi: 10.1002/pds.4583..
Keywords: Diagnostic Safety and Quality, Kidney Disease and Health, Chronic Conditions, Adverse Drug Events (ADE), Medication, Adverse Events
Bergl PA, Nanchal RS, Singh H
Diagnostic error in the critically ill: defining the problem and exploring next steps to advance intensive care unit safety.
Despite progress in ICU safety, diagnostic errors remain largely unexplored and under-studied in critical care. Compared to other safety problems, diagnostic errors are more difficult to identify and, due to the intricacies of the diagnostic process, are more difficult to unravel. This paper discusses diagnostic error in critically ill patients, defines the problem and explores next steps to advance ICU safety.
AHRQ-funded; HS022087.
Citation: Bergl PA, Nanchal RS, Singh H .
Diagnostic error in the critically ill: defining the problem and exploring next steps to advance intensive care unit safety.
Ann Am Thorac Soc 2018 Aug;15(8):903-07. doi: 10.1513/AnnalsATS.201801-068PS..
Keywords: Adverse Events, Critical Care, Diagnostic Safety and Quality, Intensive Care Unit (ICU), Medical Errors, Patient Safety