Feasibility of patient-reported diagnostic errors following emergency department discharge: a pilot study
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Kelly T. Gleason
,
Susan Peterson
Abstract
Objectives
The National Academy of Medicine identified diagnostic error as a pressing public health concern and defined failure to effectively communicate the diagnosis to patients as a diagnostic error. Leveraging Patient’s Experience to improve Diagnosis (LEAPED) is a new program for measuring patient-reported diagnostic error. As a first step, we sought to assess the feasibility of using LEAPED after emergency department (ED) discharge.
Methods
We deployed LEAPED using a cohort design at three EDs within one academic health system. We enrolled 59 patients after ED discharge and queried them about their health status and understanding of the explanation for their health problems at 2-weeks, 1-month, and 3-months. We measured response rates and demographic/clinical predictors of patient uptake of LEAPED.
Results
Of those enrolled (n=59), 90% (n=53) responded to the 2-week post-ED discharge questionnaire (1 and 3-month ongoing). Of the six non-responders, one died and three were hospitalized at two weeks. The average age was 50 years (SD 16) and 64% were female; 53% were white and 41% were black. Over a fifth (23%) reported they were not given an explanation of their health problem on leaving the ED, and of those, a fourth (25%) did not have an understanding of what next steps to take after leaving the ED.
Conclusions
Patient uptake of LEAPED was high, suggesting that patient-report may be a feasible method of evaluating the effectiveness of diagnostic communication to patients though further testing in a broader patient population is essential. Future research should determine if LEAPED yields important insights into the quality and safety of diagnostic care.
Funding source: U.S. Department of Health and Human Services
Funding source: National Institutes of Health
Funding source: National Center for Advancing Translational Sciences
Funding source: Institute of Clinical and Translational Research/Institutional Career Development Core/KL2 TR0030
Funding source: National Institute of Nursing Research Hopkins Center
Award Identifier / Grant number: P30NR019083
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Research funding: U.S. Department of Health and Human Services, National Institutes of Health, National Center for Advancing Translational Sciences, Institute of Clinical and Translational Research/Institutional Career Development Core/KL2 TR0030. U.S. Department of Health and Human Services, National Institutes of Health, National Institute of Nursing Research Hopkins Center to Promote Resilience in Persons and families living with multiple chronic conditions (the PROMOTE Center), P30NR019083.
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Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
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Competing interests: David Newman-Toker was supported by the Armstrong Institute Center for Diagnostic Excellence, Johns Hopkins University School of Medicine.
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Informed consent: Informed consent was obtained from all individuals included in this study.
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Ethical approval: The Institutional Review Board approved this study (JHM IRB00202800).
References
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Supplementary Material
The online version of this article offers supplementary material (https://doi.org/10.1515/dx-2020-0014).
© 2020 Walter de Gruyter GmbH, Berlin/Boston
Artikel in diesem Heft
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- Diagnosis of mast cell activation syndrome: a global “consensus-2”
- Opinion Papers
- Re-thinking morbidity and mortality
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- Using the NAM diagnostic process framework to teach clinical reasoning in computerized case presentations to 251 medical students
- The variability in how physicians think: a casebased diagnostic simulation exercise
- Missed acute myocardial infarction in the emergency department-standardizing measurement of misdiagnosis-related harms using the SPADE method
- Feasibility of patient-reported diagnostic errors following emergency department discharge: a pilot study
- An estimate of missed pediatric sepsis in the emergency department
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Artikel in diesem Heft
- Frontmatter
- Editorial
- Machine learning in laboratory diagnostics: valuable resources or a big hoax?
- Review
- Diagnosis of mast cell activation syndrome: a global “consensus-2”
- Opinion Papers
- Re-thinking morbidity and mortality
- Improving diagnosis by feedback and deliberate practice: one-on-one coaching for diagnostic maturation
- Original Articles
- Using the NAM diagnostic process framework to teach clinical reasoning in computerized case presentations to 251 medical students
- The variability in how physicians think: a casebased diagnostic simulation exercise
- Missed acute myocardial infarction in the emergency department-standardizing measurement of misdiagnosis-related harms using the SPADE method
- Feasibility of patient-reported diagnostic errors following emergency department discharge: a pilot study
- An estimate of missed pediatric sepsis in the emergency department
- Head Computed tomography during emergency department treat-and-release visit for headache is associated with increased risk of subsequent cerebrovascular disease hospitalization
- A diagnostic time-out to improve differential diagnosis in pediatric abdominal pain
- Development of a rubric for assessing delayed diagnosis of appendicitis, diabetic ketoacidosis and sepsis
- Between Web search engines and artificial intelligence: what side is shown in laboratory tests?
- Impact of water temperature on reconstitution of quality controls for routine hemostasis testing
- Development of an algorithm for the identification of leukemic hematolymphoid neoplasms in Primary Care patients
- Establishing a stable platform for the measurement of blood endotoxin levels in the dialysis population
- Brazilian laboratory indicators benchmarking program: three-year experience on pre-analytical quality indicators
- The accuracy of nipple discharge cytology in detecting breast cancer
- Letter to the Editor
- Results of a hospital survey on critical values communication
- Online Only: Congress Abstracts
- The Diagnostic Error in Medicine 13th Annual International Conference
