Negative emotions can adversely impact perception of both patient safety and personal risks. In this study, emergency nurses were surveyed about their emotions (e.g., afraid, calm), emotional suppression and reappraisal behaviors, and perceived risk of personal and patient safety during the COVID-19 pandemic. Nurses reported feeling both positive and negative emotions, but only negative emotions were significantly associated with greater perception of risk.

… are an effective interprofessional learning format. … Gleason KT, Commodore-Mensah Y, Wu AW, et al. Massive open …

To reduce diagnostic errors, the National Academy of Medicine (NAM) recommends increasing nursing engagement in the diagnostic process. This article reviews the current state of diagnostic education in nursing training and suggests inter-professional individual and team-based competencies to improve diagnostic safety.

… did not understand the next steps after leaving the ED. … Gleason KT, Peterson S, Dennison Himmelfarb CR, et al. Feasibility of …

The symptom-disease pair analysis of diagnostic error approach, or SPADE approach, measures diagnostic errors resulting in adverse events using two analytic pathways – the ‘look back’ analysis identifies symptoms associated with adverse events and identifies the symptom-specific harm rate per hospitalization and the ‘look forward’ analysis measures the disease-specific harm rate per symptomatic discharge. Using data from 2009 to 2017, this retrospective analysis looked at Emergency Department (ED) visits within 30 days of a hospitalization for acute myocardial infarction (AMI) to identify symptoms linked to probable missed diagnoses. Within 30 days of a subsequent hospitalization for AMI, common ED discharge diagnoses included chest pain and dyspnea, representing 574 probable missed AMIs. The authors estimate that these results correspond to approximately 10,000 potentially-preventable harms annually in the United States.  

This study analyzed malpractice claims to characterize nursing involvement in diagnosis-related (n=139) and failure-to-monitor malpractice (n=647) claims. The most common contributing factors included inadequate communication among providers (55%), failure to respond (41%), and documentation failures (28%). Both diagnosis-related and physiologic monitoring cases listing communication failures among providers as a contributing factor were associated with a higher risk of death (odds ratio [OR]=3.01 and 2.21, respectively). Healthcare organizations need to take actions to enhance nurses’ knowledge and skills to be better engage them in the diagnostic process, such as competency training and assessment.

This commentary provides a clinical review of a missed diagnosis of Epstein-Barr virus infection that was identified via autopsy and summarizes contributing factors to the incident with an emphasis on the role of cognitive bias. The piece includes the perspectives of the patient's family and from the organization regarding what happened and what could have been done to prevent this outcome. This discussion is the first in a series of diagnostic error case presentations to be published in this journal.

In light of recent expert analysis and improvement work, the concept of treating diagnosis as team activity is gaining acceptance. This review describes a framework for engaging nurses in the diagnostic process to enhance multidisciplinary teamwork and patient involvement. The authors suggest improvements in health care culture is required to implement the recommended changes, which include a focus on creating opportunities for shifting the process to be more patient centered.

Teamwork has been highlighted as a key component of patient safety that also applies to improving diagnosis. This commentary describes how the team approach to diagnosis is anchored in patient-centered care and suggests that the diagnostic team must expand beyond the focus on physicians and involve a wide range of professionals, including pathologists, allied health practitioners, and medical librarians.

According to this study, information regarding the plan of care was generally accurately transmitted during resident handoffs in the emergency department. However, medications were often omitted and residents were frequently interrupted.