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The PSNet Collection: All Content

The AHRQ PSNet Collection comprises an extensive selection of resources relevant to the patient safety community. These resources come in a variety of formats, including literature, research, tools, and Web sites. Resources are identified using the National Library of Medicine’s Medline database, various news and content aggregators, and the expertise of the AHRQ PSNet editorial and technical teams.

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Displaying 1 - 20 of 26 Results
Fawzy A, Wu TD, Wang K, et al. JAMA Intern Med. 2022;182:730-738.
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.
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.
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.
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.  
WebM&M Case April 28, 2021

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.

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.   

Skin of Color Society Foundation, NEJM Group, and VisualDx. October 28--December 2, 2020.

Diagnostic decision making can be affected by implicit racial bias. This 4-part series explored tools and techniques to improve diagnosis in patients of color. Topics covered included structural racism, explicit analysis of disease patterns and treatments, cultural competency, and policy improvement.   
Ferrara G, De Vincentiis L, Ambrosini-Spaltro A, et al. Am J Clin Pathol. 2021;155:64-68.
The COVID-19 pandemic has led to patients delaying or forgoing necessary health care.  Comparing the same 10-week period in 2018, 2019 and 2020, researchers used data from seven hospitals in northern-central Italy to assess the impact of COVID-19 on cancer diagnoses. Compared to prior years, cancer diagnoses overall fell by 45% in 2020. Researchers noted the largest decrease in cancer diagnoses among skin, colorectal, prostate, and bladder cancers.  
Stark N, Kerrissey M, Grade M, et al. West J Emerg Med. 2020;21:1095-1101.
This article describes the development and implementation of a digital tool to centralize and standardize COVID-19-related resources for use in the emergency department (ED). Clinician feedback suggests confirms that the tool has affected their management of COVID-19 patients. The tool was found to be easily adaptable to accommodate rapidly evolving guidance and enable organizational capacity for improvisation and resiliency.  
Zolnikov T, Zolnikov TR. J Prim Care Community Health. 2020;11:215013272095986.
This commentary describes the challenges of traditional approaches to differential diagnosis during the COVID-19 pandemic. The authors suggest the use of a “bottom-up” approach to diagnosis, which first eliminates the rare and/or serious diagnoses before moving on to more common diagnoses, thereby ensuring that all patients are screened for more serious diseases and improving timely diagnosis.     
Auerbach AD, O'Leary KJ, Greysen SR, et al. J Hosp Med. 2020;15:483-488.
Based on a survey of hospital medicine groups at academic medical centers in the United States (conducted April 2020), the authors of this study characterized inpatient adaptations to care for non-ICU COVID-19 patients. Sites reported rapid expansion of respiratory isolation units (RIUs – dedicated units for patients with known or suspected COVID-19), an emphasis on telemedicine for patient evaluation, and implementation of approaches to minimize room entry. In addition, nearly half of responding sites reported diagnostic errors involving COVID-19 (missing non-COVID-19 diagnoses among infected patients and missing COVID-19 diagnoses in patients admitted for other reasons).
Boyle JG, Walters MR, Jamieson S, et al. Diagnosis (Berl). 2020;7:177-179.
In this Letter to the Editor, the authors suggest that the COVID-19 pandemic presents a unique opportunity to consider how situational factors impact clinical reasoning performance and lead to errors. The authors discuss the potential implications through a clinical story involving a redeployed resident working in a COVID-19 assessment and treatment unit and an older man with respiratory symptoms. 
Schiff GD, Mirica MM. Diagnosis (Berl). 2020;7:377-380.
This commentary discuses key issues related to diagnostic accuracy in the era of COVID-19, including considering differential diagnoses for COVID-19, the challenges of remote diagnoses, and the consequences of lapses in routine diagnostic and preventive care.
Brown L. Diagnosis (Berl). 2020;7:83-84.
This editorial describes one clinician’s experience treating a patient during the early stages of the COVID-19 pandemic, and the impacts of “COVID blindness” and anchoring bias, which resulted in delayed sepsis treatment for this patient.
Peyrony O, Marbeuf-Gueye C, Truong V, et al. Ann Emerg Med. 2020;76:405-412.
This prospective study enrolled all patients with suspected COVID-19 who were tested for SARS-CoV-2 in order to estimate the diagnostic accuracy of patients’ characteristics and emergency physician judgement in predicting COVID-19. Findings indicate that physician clinical judgement was generally accurate and that certain patient characteristics (loss of smell, lung ultrasound findings) increase the likelihood of identifying COVID-19.
Struyf T, Deeks JJ, Dinnes J, et al. Cochrane Database of Syst Rev. 2020;7:Cd013665.
This systematic review of 16 studies (7,706 patients) assessed the diagnostic accuracy of signs and symptoms to determine if a patient presenting to a primary care or hospital setting has COVID-19. The authors identified data on 27 different signs and symptoms, but the individual signs and symptoms appear to have very poor diagnostic accuracy. The authors conclude that based on currently available data, neither the absence nor presence of signs or symptoms are accurate enough to rule a COVID-19 diagnosis in or out.
Coleman JJ, Manavi K, Marson EJ, et al. Postgrad Med J. 2020;96:392-398.
Many COVID-19 patients present with respiratory symptoms, but others may present with atypical symptoms (e.g., delirium, smell and taste dysfunction, cardiovascular features). This article summarizes the evidence regarding these atypical presentations and the importance of physicians considering conditions which can “mimic” COVID-19 as part of the differential diagnoses in order to avoid diagnostic uncertainty and diagnostic errors.