Use of an Expedited Review Tool to Screen for Prior Diagnostic Error in Emergency Department XXXX .

@entity1 @entity341
OBJECTIVE: Missed diagnoses are an important area of care quality resulting in significant morbidity and mortality. Determination of rates and causes has been limited by difficulties in screening, including the effort of manual chart review. We developed and tested a semi- automated review tool to expedite screening for diagnostic errors in an electronic health record (EHR). METHODS: We retrospectively reviewed @entity1 seen in the @entity341 ( @entity341 ) of a teaching hospital over 31 days, using an automated screen to identify those with a prior in-system visit during the 14 days preceding their @entity341 visit. We collected prior and subsequent notes from the institution's EHR for these cases, then populated a specially designed relational database enabling rapid comparison of prior visit records to the sentinel @entity341 visit. Each case was assessed for potential missed or delayed diagnosis, and rated by likelihood as "definite, probable, possible, unlikely or none." RESULTS: A total of 5 066 @entity1 encounters were screened by a clinician using the tool, of which 1 498 (30%) had a clinical encounter within the preceding 14 days. Of these, 37 encounters (2.6% of those reviewed) were "definite" or "probable" missed diagnoses. The rapid review tool took a mean of 1.9 minutes per case for primary review, compared with 11.2 minutes per case for reviews without the automated tool. CONCLUSIONS: Diagnostic errors were present in a significant number of cases presenting to the @entity341 after recent healthcare visits. An innovative review tool enabled a substantially increased efficiency in screening for diagnostic errors.
