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- Communication Improvement 2
- Culture of Safety 1
- Error Reporting and Analysis 1
- Human Factors Engineering 1
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- Quality Improvement Strategies 2
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- Technologic Approaches 1
Search results for "Diagnostic Errors"
Journal Article > Commentary
Groszkruger D. J Healthc Risk Manag. 2014;34:38-43.
Highlighting how uncertainty around identifying diagnostic errors hinders measuring its incidence and developing solutions, this commentary outlines methods to augment diagnostic safety including teamwork activities, establishing best practices, and utilizing decision support systems.
Journal Article > Review
Thammasitboon S, Thammasitboon S, Singhal G. Curr Probl Pediatr Adolesc Health Care. 2013;43:242-247.
This review describes methods to address system and cognitive weaknesses in the diagnostic process.
Journal Article > Review
Winters B, Custer J, Galvagno SM Jr, et al. BMJ Qual Saf. 2012;21:894-902.
In the quest to improve patient safety, diagnostic errors have been underemphasized and as a result have been termed the "next frontier" for the safety field. This systematic review of autopsy studies sought to estimate the incidence of diagnostic errors contributing to death (class I errors) in intensive care unit (ICU) patients, compared with a prior systematic review that identified a 4.1% class I error rate across all patients undergoing autopsy. This review, which included 31 separate studies, found an overall class I error rate of 8% in ICU patients, with vascular events and infections accounting for most missed diagnoses. Despite the continuing utility of autopsies in improving diagnostic performance, autopsy rates in the United States have been steadily declining, leading to calls for efforts to increase autopsy rates.
Journal Article > Study
Early readmissions to the department of medicine as a screening tool for monitoring quality of care problems.
Balla U, Malnick S, Schattner A. Medicine (Baltimore). 2008;87:294-300.
Unplanned readmissions within 30 days of discharge were associated with problems in the quality of care, including inadequate diagnostic workup and diagnostic error.
Cases & Commentaries
- Web M&M
Arpana Vidyarthi, MD; March 2004
Due to a series of incomplete signouts, information about a patient's post-operative leg pain and chest discomfort is not conveyed to the primary team. A PE is discovered post-mortem.