Project Grant K08HS029534

DETECTING AND CHARACTERIZING DIAGNOSTIC ERRORS AMONG HIGH-RISK PATIENTS DISCHARGED FROM THE EMERGENCY DEPARTMENT - PROJECT SUMMARY IN THE U.S., EMERGENCY DEPARTMENTS (EDS) CARE FOR >130 MILLION PATIENTS EACH YEAR. CURRENT ESTIMATES SUGGEST THAT 5% OF ALL ED PATIENTS EXPERIENCE A DIAGNOSTIC ERROR, LEADING TO HARM FOR 2.5 MILLION ED PATIENTS AND DEATH OR PERMANENT DISABILITY FOR 350,000 EACH YEAR. THE VAST MAJORITY OF ED PATIENTS-ABOUT 85%-ARE DISCHARGED WITHOUT INPATIENT ADMISSION, AND THERE ARE NO COMMONLY USED SYSTEMS IN PLACE TO DETECT DIAGNOSTIC ERRORS OR REPORT THEM TO ED ADMINISTRATORS. THIS "BLIND SPOT" PLACES PATIENTS AT RISK FOR HARM AFTER ED DISCHARGE AND INHIBITS IMPROVEMENTS IN ED DIAGNOSTIC PROCESSES. OUR RESEARCH AIMS ARE: (1) TO DETECT AND CHARACTERIZE DIAGNOSTIC ERRORS AMONG HIGH-RISK PATIENTS DISCHARGED FROM THE ED; (2) TO DETECT AND CHARACTERIZE OUTCOMES RESULTING FROM DIAGNOSTIC ERRORS, INCLUDING HEALTHCARE UTILIZATION, SEVERITY OF HARM, AND PATIENT-REPORTED NONCLINICAL IMPACTS; AND (3) TO ASCERTAIN AND CHARACTERIZE THE WORK-SYSTEM FACTORS CONTRIBUTING TO DIAGNOSTIC ERRORS. WE WILL ENROLL 300 ENGLISH- AND SPANISH-SPEAKING PATIENTS WHO ARE HIGH RISK FOR EXPERIENCING HARMS IF ERRORS OCCUR BECAUSE OF THEIR ADVANCED AGE, COMORBID CHRONIC CONDITIONS, AND URGENT ED TRIAGE SCORES. IN RESPONSE TO RECOMMENDATIONS FROM AHRQ AND THE NATIONAL ACADEMY OF MEDICINE, WE WILL USE MULTIPLE DATA SOURCES TO DETECT AND CHARACTERIZE ERRORS, INCLUDING PHONE FOLLOW-UP WITH PATIENTS, QUESTIONNAIRES ADMINISTERED TO TREATING ED PHYSICIANS AND NURSES, AND STRUCTURED MEDICAL RECORD REVIEW. IN ACCORDANCE WITH BEST PRACTICES IN PATIENT SAFETY RESEARCH, ALL STUDY MEASURES WILL BE DETERMINED THROUGH DUAL-REVIEWER ADJUDICATION OF STUDY DATA. WE ANTICIPATE THAT WE WILL DETECT DIAGNOSTIC ERRORS IN 20% OF CASES, WHICH IS FOUR TIMES THE 5% ERROR RATE THAT WAS REPORTED IN A RECENT SYSTEMATIC REVIEW. OUR RESULTS WILL INFORM AND MOTIVATE CONTINUOUS QUALITY IMPROVEMENT EFFORTS LOCALLY AND NATIONWIDE BY EDUCATING ADMINISTRATORS, SAFETY OFFICERS, CLINICIANS, AND PATIENT ADVOCATES THAT ERRORS AND HARMS FROM ERRORS ARE MORE COMMON THAN PREVIOUSLY SUSPECTED. MOREOVER, OUR RESEARCH INTO THE WORK-SYSTEM FACTORS CONTRIBUTING TO ERRORS WILL DIRECT SYSTEM-BASED APPROACHES TO PREVENT DIAGNOSTIC ERRORS AND PROTECT PATIENTS FROM HARM. PART OF A K08 AWARD PROGRAM, THIS WORK WILL TRAIN THE PI IN PATIENT SAFETY AND DIAGNOSTIC ERROR RESEARCH METHODS; PATIENT AND CLINICIAN ENGAGEMENT IN QUALITY IMPROVEMENT/DIAGNOSTIC ERROR RESEARCH; AND HUMAN FACTORS ENGINEERING. GIVEN STRONG MENTORING AND INSTITUTIONAL SUPPORT, THIS K08 AWARD WILL LAUNCH THE PI'S CAREER AS AN EXPERT IN SOLVING PROBLEMS WITH THE QUALITY AND SAFETY OF EMERGENCY CARE, AND IT WILL PREPARE HIM TO CONDUCT LARGE-SCALE STUDIES TO DEVELOP SOLUTIONS THAT PROTECT PATIENTS FROM HARM DUE TO DIAGNOSTIC ERRORS.