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Meyer AND, Giardina TD, Khawaja L, et al. Patient Educ Couns. 2021;104:2606-2615.
Diagnostic uncertainty can lead to misdiagnosis and delayed treatment. This article provides an overview of the literature on diagnosis-related uncertainty, where uncertainty occurs in the diagnostic process and outlines recommendations for managing diagnostic uncertainty.
Pinnock R, Ritchie D, Gallagher S, et al. Adv Health Sci Educ Theory Pract. 2021;26:785-809.
Cognition is a recognized human factor that can contribute to medical error. This systematic review explored whether mindful practice can improve diagnosis in healthcare. Of the 33 included studies, the majority were non-empirical; however, the authors tentatively conclude that mindful practice may be a promising method to improve diagnostic accuracy and reduce error.

Bajaj K, de Roche A, Goffman D. Rockville, MD: Agency for Healthcare Research and Quality; September 2021. AHRQ Publication No. 20(21)-0040-6-EF.

Maternal safety is threatened by systemic biases, care complexities, and diagnostic issues. This issue brief explores the role of diagnostic error in maternal morbidity and mortality, the preventability of common problems such as maternal hemorrhage, and the importance of multidisciplinary efforts to realize improvement. The brief focuses on events occurring during childbirth and up to a week postpartum.
Burrus S, Hall M, Tooley E, et al. Pediatrics. 2021;148:e2020030346.
Based on analysis of four years of data submitted to the Child Health Patient Safety Organization (CHILDPSO), researchers sought to identify types of serious safety events and contributing factors. Three main groups of serious safety events were identified: patient care management, procedural errors, and product or device errors. Contributing factors included lack of situational awareness, process failures, and failure to communicate effectively.
Dave N, Bui S, Morgan C, et al. BMJ Qual Saf. 2022;31:297-307.
This systematic review provides an update to McDonald et al’s 2013 review of strategies to reduce diagnostic error.  Technique (e.g., changes in equipment) and technology-based (e.g. trigger tools) interventions were the most studied intervention types. Future research on educational and personnel changes would be useful to determine the value of these types of interventions.

National Academies of Sciences, Engineering, and Medicine. Washington, DC: The National Academies Press; 2021.

Misdiagnosis of severe cardiovascular events is a primary concern to the diagnostic safety community due to its prevalence and potential for harm. This report summarizes a session discussion on the existing evidence base on improving diagnosis for these conditions and explore opportunities for improvement.
Miller-Kleinhenz JM, Collin LJ, Seidel R, et al. J Am Coll Radiol. 2021;18:1384-1393.
Delayed diagnosis and treatment of breast cancer can lead to poor outcomes. Based on multi-year data from one health system, the authors of this cohort study found that black women with screen-detected breast cancers were more likely than white women to experience diagnostic delays, including delays in diagnostic evaluation and biopsy. The delay in diagnosis was also associated with an increase in breast cancer mortality.
Alexander RG, Yazdanie F, Waite S, et al. Front Neurosci. 2021;15:629469.
Incorrect interpretation of radiologic images can result in delayed diagnosis or unneeded additional tests and treatment. This commentary describes the visual illusions radiologists use in detecting and categorizing abnormalities, and recommends further research into the ways visual illusions are used in order to improve diagnostic safety.
Bulliard J‐L, Beau A‐B, Njor S, et al. Int J Cancer. 2021;149:846-853.
Overdiagnosis of breast cancer and the resulting overtreatment can cause physical, emotional, and financial harm to patients. Analysis of observational data and modelling indicates overdiagnosis accounts for less than 10% of invasive breast cancer in patients aged 50-69. Understanding rates of overdiagnosis can assist in ascertaining the net benefit of breast cancer screening.

Houston, TX:  Baylor College of Medicine.

This Center represents a partnership with the Veterans Affairs Health Services Research & Development Center of Innovation to enhance researchers' skills through active participation in diagnostic safety research and policy development. The goals of the program include a focus on behavioral health interventions and measurement.
Wong CW, Tafuro J, Azam Z, et al. J Cardiac Failure. 2021;27:925-933.
Misdiagnosis of cardiovascular conditions can lead to serious patient harm. This systematic review explored misdiagnosis of heart failure. Based on 10 included studies, the rate of heart failure misdiagnosis ranged from 16.1% (in an inpatient setting) to 68.5% (when general practitioners referred patients to specialists). Included studies found that heart failure is frequently misdiagnosed as chronic obstructive pulmonary disease (COPD).
Oberlander T, Scholle SH, Marsteller JA, et al. J Healthc Qual. 2021;43:324-339.
The goal of the patient centered medical home (PCMH)  model is to reorganize primary care to provide team-based, coordinated, accessible health care. This study used a consensus process with input from a physician panel to examine ambulatory patient safety concerns (e.g., medication safety, diagnostic error, treatment delays, communication or coordination errors) in the context of the PCMH model and explore variability in the implementation of patient safety practices.

Patel J, Otto E, Taylor JS, et al. Dermatol Online J. 2021;27(3).

In an update to their 2010 article, this review’s authors summarized the patient safety literature in dermatology from 2009 to 2020. In addition to topics covered in the 2010 article, this article also includes diagnostic errors related to telemedicine, laser safety, scope of practice, and infections such as COVID-19. The authors recommend further studies, and reports are needed to reduce errors and improve patient safety.
Horberg MA, Nassery N, Rubenstein KB, et al. Diagnosis (Berl). 2021;8:479-488.
Missed or delayed diagnosis of sepsis can lead to serious patient harm. This study used a Symptom-Disease Pair Analysis of Diagnostic Error (SPADE) “look-forward” analysis to measure potential misdiagnosis of sepsis in patients discharged from the emergency department (ED) with treat-and-release fluid and electrolyte disorders (FED) or altered mental status (AMS). FED and AMS were associated with a spike in sepsis hospitalizations in the 7-day period following the ED visit. The authors suggest SPADE could be used to compare sepsis diagnostic performance across institutions and regions; develop interventions for targeted subgroups; and update early warning systems for sepsis diagnosis.
Fuller G, Pandor A, Essat M, et al. J Trauma Acute Care Surg. 2021;90:403-412.
Prehospital triage tools are used to differentiate between patients who need emergency care at a major trauma center (MTC) and those that may receive adequate care at a non-MTC.  Accurate triage tools are necessary to ensure that patients are not over- or undertriaged. This review found high variability in sensitivity and specificity across geriatric triage tools indicating some patients may not be receiving the specialized trauma care they need. The authors highlight several future research targets including development of relevant reference standards and balancing the risk between over- and undertriage.
Cifra CL, Custer JW, Singh H, et al. Pediatr Crit Care Med. 2021;22:701-712.
Diagnostic errors continue to be a patient safety concern, including in pediatric critical care. This systematic review explored the prevalence, impact, and contributing factors to diagnostic errors in the pediatric intensive care unit (PICU). The most common diagnostic errors occurred in cardiovascular, infectious, congenital, and neurologic conditions; cognitive and systems factors were associated with diagnostic errors. Future research should focus on disease- and systems-level determinants. 
Vasey B, Ursprung S, Beddoe B, et al. JAMA Netw Open. 2021;4:e211276.
This study explored the role of machine-learning based clinical decision support (CDS) algorithms to support (rather than replace) human decision-making and the impact on diagnostic performance. This systematic review of 37 studies found limited evidence that the use of machine learning-based CDS systems contributes to improved diagnostic performance among clinicians. Interobserver agreement, user feedback, and clinician override were the most commonly reported outcomes. The authors emphasize the importance of further evaluation of human-computer interaction.
Kostopoulou O, Tracey C, Delaney BC. J Am Med Inform Assoc. 2021;28:1461-1467.
In addition to being used for patient-specific clinical purposes, data within the electronic health record (EHR) may be used for other purposes including epidemiological research. Researchers in the UK developed and tested a clinical decision support system (CDSS) to evaluate changes in the types and number of observations that primary care physicians entered into the EHR during simulated patient encounters. Physicians documented more clinical observations using the CDSS compared to the standard electronic health record. The increase in documented clinical observations has the potential to improve validity of research developed from EHR data.

Jørgensen IF, Brunak S. NPJ Digital Med. 2021;4(1):12.

Overdiagnosis is a growing area of concern within patient safety. The authors present a generalizable approach for identifying patients at risk of being mis- or overdiagnosed. Using chronic obstructive pulmonary disease (COPD) patients as an example, the authors outline how to create significant, temporal disease trajectories, and compare similarities between these disease trajectories and individual patient disease histories to identify the cases that may signal overdiagnosis.
Olson APJ, Linzer M, Schiff GD. J Gen Intern Care. 2021;36:1404-1406.
Challenges to identifying and measuring diagnostic errors, particularly in the era of COVID-19, persist. The authors of this perspective proposed a new framework of diagnostic process safety to measure the quality and safety of diagnostic processes. The framework focuses on three measurable components – do not miss diagnoses, red flags, and diagnostic pitfalls. This framework can provide a structured approach for designing and testing specific measures of diagnostic process safety.