Prevalence and Causes of Diagnostic Errors in Hospitalized Patients Under Investigation for COVID-19.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Auerbach Andrew D, Astik Gopi J, O'Leary Kevin J, Barish Peter N, Kantor Molly A, Raffel Katie R, Ranji Sumant R, Mueller Stephanie K, Burney Sharran N, Galinsky Janice, Gershanik Esteban F, Goyal Abhishek, Chitneni Pooja R, Rastegar Sarah, Esmaili Armond M, Fenton Cynthia, Virapongse Anunta, Ngov Li-Kheng, Burden Marisha, Keniston Angela, Patel Hemali, Gupta Ashwin B, Rohde Jeff, Marr Ruby, Greysen S Ryan, Fang Michele, Shah Pranav, Mao Frances, Kaiksow Farah, Sterken David, Choi Justin J, Contractor Jigar, Karwa Abhishek, Chia David, Lee Tiffany, Hubbard Colin C, Maselli Judith, Dalal Anuj K, Schnipper Jeffrey L
Аннотация
OBJECTIVE: To determine the frequency of DEs and their causes among patients hospitalized under investigation (PUI) for COVID-19.
DESIGN: Retrospective cohort.
SETTING: Eight medical centers affiliated with the Hospital Medicine ReEngineering Network (HOMERuN).
TARGET POPULATION: Adults hospitalized under investigation (PUI) for COVID-19 infection between February and July 2020.
MEASUREMENTS: We randomly selected up to 8 cases per site per month for review, with each case reviewed by two clinicians to determine whether a DE (defined as a missed or delayed diagnosis) occurred, and whether any diagnostic process faults took place. We used bivariable statistics to compare patients with and without DE and multivariable models to determine which process faults or patient factors were associated with DEs.
RESULTS: Two hundred and fifty-seven patient charts underwent review, of which 36 (14%) had a diagnostic error. Patients with and without DE were statistically similar in terms of socioeconomic factors, comorbidities, risk factors for COVID-19, and COVID-19 test turnaround time and eventual positivity. Most common diagnostic process faults contributing to DE were problems with clinical assessment, testing choices, history taking, and physical examination (all p < 0.01). Diagnostic process faults associated with policies and procedures related to COVID-19 were not associated with DE risk. Fourteen patients (35.9% of patients with errors and 5.4% overall) suffered harm or death due to diagnostic error.
LIMITATIONS: Results are limited by available documentation and do not capture communication between providers and patients.
CONCLUSION: Among PUI patients, DEs were common and not associated with pandemic-related care changes, suggesting the importance of more general diagnostic process gaps in error propagation.