Implementation of electronic triggers to identify diagnostic errors in emergency departments.
Vaghani V, Gupta A, Mir U, et al. Implementation of electronic triggers to identify diagnostic errors in emergency departments. JAMA Intern Med. 2025;185(2):143-151. doi:10.1001/jamainternmed.2024.6214.
Diagnostic errors continue to be a source of preventable harm. Researchers in this study developed and implemented electronic triggers (e-triggers) to identify missed opportunities for diagnosis (MOD) in Veterans Affairs emergency departments (ED) between 2016 and 2020. The e-triggers targeted six clinical scenarios: high-risk stroke, high-risk abdominal pain, unexpected ED or hospital return, concerning symptom-disease dyads (e.g., heart attack within 7 days of ED visit for chest pain), and lack of follow-up after abnormal test results. In a sample of 8.7 million treat-and-release ED visits, e-triggers showed modest positive predictive value (from 11.0% to 52.4%). The researchers found that most MODs (83%) involved process breakdowns during the clinician-patient encounter, such as failure to complete a physical examination or review previous documentation.