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Fawzy A, Wu TD, Wang K, et al. JAMA Intern Med. 2022;Epub May 31.
Black and brown patients have experienced disproportionately poorer outcomes from COVID-19 infection as compared with white patients. This study found that patients who identified as Asian, Black, or Hispanic may not have received timely diagnosis or treatment due to inaccurately measured pulse oximetry (SpO2). These inaccuracies and discrepancies should be considered in COVID outcome research as well as other respiratory illnesses that rely on SpO2 measurement for treatment.

National Academies of Sciences, Engineering, and Medicine. Washington, DC: The National Academies Press; 2022.

The COVID-19 crisis affected most health care processes, including diagnosis. This report recaps a session examining impacts of the pandemic on diagnostic approaches, inequities, and innovations that may inform future diagnostic improvement efforts.
Wieringa S, Neves AL, Rushforth A, et al. BMJ Qual Saf. 2022;Epub Mar 8.
The COVID-19 pandemic dramatically increased the use of telehealth, including remote primary care triage and assessment. This qualitative study explored patients’ and clinicians’ experiences managing suspected COVID-19 during remote triage and assessment. Findings highlight the need to strengthen organizational resilience, develop and implement triage decision support tools, and address vulnerable and unsupported groups (e.g., the elderly, vulnerable and homebound patients).
Mullur J, Chen Y-C, Wickner PG, et al. J Patient Saf. 2022;18:e431-e438.
COVID-19 restrictions and patient safety concerns have greatly expanded the use of telehealth and virtual visits. Through patient satisfaction surveys and patient complaints, this US hospital evaluated the quality and safety of virtual visits in March and April of 2020. Five patient complaints were submitted during this timeframe and overall patient satisfaction remained high. Safety and quality risks were identified (e.g., diagnostic error) and best practices were established.
Coen M, Sader J, Junod-Perron N, et al. Intern Emerg Med. 2022;17:979-988.
The uncertainty and pressure of the COVID-19 pandemic can introduce cognitive biases leading to diagnostic errors. Researchers asked primary care providers taking care of COVID-19 adult patients to describe cases when their clinical reasoning was “disrupted” due to the pandemic. The most common cognitive biases were anchoring bias, confirmation bias, availability bias, and cognitive dissonance.
Khoong EC, Sharma AE, Gupta K, et al. J Gen Intern Med. 2022;37:1270-1274.
In response to concerns about COVID-19 transmission, many ambulatory care visits have transitioned to telehealth visits. This commentary describes the impact of telehealth on diagnostic errors and medication safety in ambulatory settings. Recommendations to further understand the impact of telemedicine on patient safety include: systematically measuring patient safety outcomes and increasing reporting of safety incidents; identifying the patients and clinical scenarios with the greatest risk of unsafe telehealth care; identifying and supporting best practices to ensure equal access to safe telehealth.
Shen L, Levie A, Singh H, et al. Jt Comm J Qual Patient Saf. 2022;48:71-80.
The COVID-19 pandemic has exacerbated existing challenges associated with diagnostic error. This study used natural language processing to identify and categorize diagnostic errors occurring during the pandemic. The study compared a review of all patient safety reports explicitly mentioning COVID-19, and using natural language processing, identified additional safety reports involving COVID-19 diagnostic errors and delays. This innovative approach may be useful for organizations wanting to identify emerging risks, including safety concerns related to COVID-19.
Fatemi Y, Coffin SE. Diagnosis (Berl). 2021;8:525-531.
Using case studies, this commentary describes how availability bias, diagnostic momentum, and premature closure resulted in delayed diagnosis for three pediatric patients first diagnosed with COVID-19. The authors highlight cognitive and systems factors that influenced this diagnostic error.

Fournier JP, Amélineau JB, Hild S, et al. Eur J Gen Pract. 2021;27(1):142-151.

The COVID-19 pandemic has raised new patient safety concerns. This study examined patient safety incidents in primary care settings in France during the early months of the COVID-19 pandemic. Of the 132 reported incidents, 44% related to delayed diagnosis, assessments and referrals. Reported incidents less commonly related to cancellation of care, home confinement-related incidents, and inappropriate medication discontinuation.

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.
DeGrave AJ, Janizek JD, Lee S-I. Nat Mach Intell. 2021;3:610–619.
Artificial intelligence (AI) systems can support diagnostic decision-making. This study evaluates diagnostic “shortcuts” learned by AI systems in detecting COVID-19 in chest radiographs. Results reveal a need for better training data, improved choice in the prediction task, and external validation of the AI system prior to dissemination and implementations in different hospitals.  

A pregnant patient was admitted for scheduled Cesarean delivery, before being tested according to a universal inpatient screening protocol for SARS-CoV-2. During surgery, the patient developed a fever and required oxygen supplementation. Due to suspicion for COVID-19, a specimen obtained via nasopharyngeal swab was sent to a commercial laboratory for reverse transcriptase polymerase chain reaction (RT-PCR) testing.

Evanston, IL: Society to Improve Diagnosis in Medicine; March 2021.

Telehealth is commonly used to deliver health care, yet its safety across the continuum has yet to be determined. This report highlights perspectives on the potential of telediagnosis and examines its reach, effectiveness, adoption, implementation, and maintenance, to inform actions to ensure its safe use.

In this PSNet Annual Perspective, we worked with co-authors Dr. Jacqueline C. Stocking, a quality improvement and critical care specialist, and Dr. Christian Sandrock, a patient safety professional and emerging infectious diseases specialist, to provide a look at news and research related to the impact of the COVID-19 pandemic on patient safety.

Muhrer JC. Nurs Pract. 2021;46:44-49.
The COVID-19 pandemic has led to wide-ranging changes to health care delivery, some of which may negatively impact patient outcomes.The authors use a syndemic perspective to discuss existing challenges interfering with diagnosis (structural, socioeconomic, patient-related, and provider-related), how the COVID-19 pandemic has exacerbated those challenges, and strategies related to nurse practitioners and community health workers to improve diagnosis.  

Diagnosis (Berl)2020;7(4):345-411.

COVID-19 is a novel coronavirus that harbors a variety of diagnostic, treatment, and management hurdles. This special issue covers a variety of clinical topics including optimal diagnostic methods, near misses, and diagnostic accuracy.   

Wu KJ. New York Times. October 25, 2020.

False-positive test results, while rare, can create conditions for patient harm. This news story discusses negative impacts of a false-positive COVID test. The unintended consequences of the mistake could be unneeded isolation, inappropriate treatment and patient exposure to infection due to isolation strategies in care facilities.