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The e-Autopsy/e-Biopsy: a systematic chart review to increase safety and diagnostic accuracy

  • Michael H. Kanter EMAIL logo , Ali Ghobadi , Lawrence D. Lurvey , Sophia Liang and Kerry Litman
Published/Copyright: September 26, 2022
Diagnosis
From the journal Diagnosis Volume 9 Issue 4

Abstract

Solving diagnostic errors is difficult and progress on preventing those errors has been slow since the 2015 National Academy of Medicine report. There are several methods used to improve diagnostic and other errors including voluntary reporting; malpractice claims; patient complaints; physician surveys, random quality reviews and audits, and peer review data which usually evaluates single cases and not the systems that allowed the error. Additionally, manual review of charts is often labor intensive and reviewer dependent. In 2010 we developed an e-Autopsy/e-Biopsy (eA/eB) methodology to aggregate cases with quality/safety/diagnostic issues, focusing on a specific population of patients and conditions. By performing a hybrid review process (cases are first filtered using administrative data followed by standardized manual chart reviews) we can efficiently identify patterns of medical and diagnostic error leading to opportunities for system improvements that have improved care for future patients. We present a detailed methodology for eA/eB studies and describe results from three successful studies on different diagnoses (ectopic pregnancy, abdominal aortic aneurysms, and advanced colon cancer) that illustrate our eA/eB process and how it reveals insights into creating systems that reduce diagnostic and other errors. The eA/eB process is innovative and transferable to other healthcare organizations and settings to identify trends in diagnostic error and other quality issues resulting in improved systems of care.

Keywords: diagnostic errors; patient safety; system improvement
Corresponding author: Michael H. Kanter, MD, Department of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine 98 S. Los Robles, 2nd Floor, Pasadena, CA 91101, USA, E-mail:

Acknowledgments

The authors thank the patients of Kaiser Permanente and their partnership with us to improve their health.

  1. Research funding: None declared.

  2. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: Authors state no conflict of interest.

  4. Informed consent: Informed consent was obtained from all individuals included in this study.

  5. Ethical approval: The KPSC Regional Institutional Review Board approved all studies.

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Supplementary Material

The online version of this article offers supplementary material (https://doi.org/10.1515/dx-2022-0083).

Received: 2022-02-04
Accepted: 2022-08-16
Published Online: 2022-09-26

© 2022 Walter de Gruyter GmbH, Berlin/Boston

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https://doi.org/10.1515/dx-2022-0083
Keywords for this article
diagnostic errors; patient safety; system improvement

Articles in the same Issue

  1. Frontmatter
  2. Review
  3. Diagnostic and therapeutic approach to hypernatremia
  4. Opinion Papers
  5. The diagnostic potential and barriers of microbiome based therapeutics
  6. Pursuit of “endpoint diagnoses” as a cognitive forcing strategy to avoid premature diagnostic closure
  7. Guidelines and Recommendations
  8. The e-Autopsy/e-Biopsy: a systematic chart review to increase safety and diagnostic accuracy
  9. Original Articles
  10. Exploring procedure-based management reasoning: a case of tension pneumothorax
  11. A structured approach to EHR surveillance of diagnostic error in acute care: an exploratory analysis of two institutionally-defined case cohorts
  12. Human centered design workshops as a meta-solution to diagnostic disparities
  13. Longitudinal clinical reasoning theme embedded across four years of a medical school curriculum
  14. Using the Assessment of Reasoning Tool to facilitate feedback about diagnostic reasoning
  15. Evolution of throat symptoms during the COVID-19 pandemic in the US
  16. Evaluating the role of a fully automated SARS-CoV-2 antigen ECLIA immunoassay in the management of the SARS COV 2 pandemic on general population
  17. miR-21-3p and miR-192-5p in patients with type 2 diabetic nephropathy
  18. Letter to the Editors
  19. Convoluted molecular maze of neprilysin
  20. OPeNet: an AI-based platform implemented to facilitate clinical reasoning by primary care practitioners, as well as the virtuous co-management of chronic patients during and after the COVID-19 pandemic in Italy
  21. Letter to the Editor in reply to Diamandis “COVID-19 and the Le Chatelier’s principle”
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