Table 4. Studies that Tested System Interventions to Address Dimensions of Diagnostic Error.
Provider-patient Encounter | |||||||
Perno, J. F., et al (2005). Significant reduction in delayed diagnosis of injury with implementation of a pediatric trauma service. Pediatr Emerg Care, 21(6), 367-371. |
UBA | Designated pediatric trauma response team |
48 months | Care team | Unknown care teams; A total of 3265 patients were included; no patients were excluded. |
Incidence of delayed diagnosis of injury (DDI) among pediatric trauma patients. |
Y; speculated reasons included team dedicated only to trauma |
Howard, J., et al. (2006). Reducing missed injuries at a level II trauma center. J Trauma Nurs, 13(3), 89-95. |
Post- test only |
Comprehensive reevaluation (i.e., tertiary examination) of trauma patients within 24 hours of admission |
6 months | A trauma clinical nurse specialist, 2 emergency physicians, and the trauma medical director |
4 healthcare providers, 90 patients |
Incidence of missed injuries |
Y; tertiary “repeat” examination and review of all lab and radiology studies |
Diagnostic Tests | |||||||
Weatherburn, et al (2000). The effect of a picture archiving and communications system (PACS) on diagnostic performance in the accident and emergency department. (J Accid Emerg Med, 17(3), 180-184.) |
CBA | Implementation of Picture Archiving and Communications System (PACS), which acquires, transports, and stores radiographic images electronically, with accident and emergency (A&E) clinicians |
Pre-PACS data collection period based on conventional film images: 3/ 31/92 to 10/30/92; Post- PACS data collection period: 4/1/96 to 10/30/96 |
Accident and emergency (A&E) department. |
# of A&E attenders: 14,256 (film), 17,071 (PACS) |
Misdiagnosis (false negative) rates for adults and children |
Y; Speculated reasons include 1) clinicians could manipulate soft copy images in PACS 2) potential for images to be viewed simultaneously in A&E and Radiology.pro mpting more consultations |
Follow-up and Tracking | |||||||
Singh, H., et al. (2009). Improving follow-up of abnormal cancer screens using electronic health records(BMC Med Inform Decis Mak, 9, 49) |
UBA | Added a code to the software configuration that links patients to their PCP for tests ordered by others. |
10 months | Primary care physicians |
One large urban facility and satellite clinics; 490 alerts |
Rates of timely follow- up of positive FOBTs pre- and post- intervention |
Y; improved electronic communication of abnormal test results |
Poon, E. G., et al (2002). Real-time notification of laboratory data requested by users through alphanumeric pagers. (J Am Med Inform Assoc, 9(3), 217-222). |
Post- test only |
Implementation of Result Notification via Alphanumeric Pagers (ReNAP), an application that notifies clinicians of patient laboratory results via an alphanumeric pager once results are filed into the patient database. |
12 months | Inpatient and clinic physicians |
During the 12 month period between Feb 2000 and Jan 2001, 780 different clinicians used ReNAP; a total of 22,775 requests were made during this time period. |
# of laboratory notification requests made, user satisfaction scores |
Y; improved electronic communication of test results |
Piva, E., et al. (2009). Evaluation of effectiveness of a computerized notification system for reporting critical values. (Am J Clin Pathol, 131(3), 432- 441.) |
UBA | Implementation of a computerized notification system for critical lab values (email, text message, video alert) |
2 months | Clinicians | 14 Departments (including Emergency Department) in one large hospital |
Percentage of successful notifications (acknowledge d within 1 hour), time to notification. |
Y; improved electronic communication of abnormal test results |
Key (study design):
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UBA (Uncontrolled before and after study)
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CBA (Controlled before and after study)
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Post-test only (measures only taken after intervention was implemented)