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Journal Article > Study
Root cause analysis reports help identify common factors in delayed diagnosis and treatment of outpatients.
Davis Giardina T, King BJ, Ignaczak AP, et al. Health Aff (Millwood). 2013;32:1368-1375.
Failure to properly follow up on test results can result in missed or delayed diagnoses. This study from the Veterans Affairs (VA) system reveals the clinical impact of inadequate care processes for patients with urgent follow-up needs. By analyzing 111 root cause analyses of diagnostic error cases in the outpatient setting, the authors determined that poorly coordinated care—arising from a lack of systems to track patients needing urgent evaluation, insufficient follow-up of abnormal test results, and inadequate communication between clinicians—contributed to most of the missed or delayed diagnoses. Although electronic medical records (EMRs) should facilitate responding to abnormal test results, prior VA studies have shown that a small but clinically significant proportion of abnormal laboratory tests and radiology studies are not acted upon in a timely fashion (despite the VA having a fully integrated EMR for more than a decade). The authors advocate for refining EMR systems to better facilitate communication between clinicians and for emphasizing teamwork training in the outpatient setting.
Journal Article > Study
Singh H, Giardina TD, Forjuoh SN, et al. BMJ Qual Saf. 2012;22:93-100.
Diagnostic errors are one of the most common types of preventable errors in ambulatory care, according to data from closed malpractice claims. Difficulty in identifying missed and delayed diagnoses has hampered progress in addressing diagnostic errors. In this case-control study, investigators assessed two triggers for identifying possible cases of diagnostic error within an electronic health record. These triggers were refined from a prior study by the same investigators. The trigger methodology was reasonably accurate in identifying likely diagnostic errors, although the study was limited by poor interrater reliability between physician reviewers on whether an error occurred. Nevertheless, this study demonstrates the potential of screening approaches within electronic medical records for identifying and categorizing possible diagnostic errors.