Feasibility and Reliability Testing of Manual Electronic Health Record Reviews as a Tool for Timely Identification of Diagnostic Error in Patients at Risk.
Feasibility and Reliability Testing of Manual Electronic Health Record Reviews as a Tool for Timely Identification of Diagnostic Error in Patients at Risk.
复制标题
手动电子健康记录审查作为及时识别高危患者诊断错误的工具的可行性和可靠性测试。
DOI：
10.1055/s-0040-1713750
复制
发表时间：
2020
影响因子：
2.9
通讯作者：
Pickering,BrianW
中科院分区：
文献类型：
--
作者：
Soleimani,Jalal;Pinevich,Yuliya;Barwise,AmeliaK;Huang,Chanyan;Dong,Yue;Herasevich,Vitaly;Gajic,Ognjen;Pickering,BrianW
背景虽然诊断错误（DE）是一个重要的问题，它仍然具有挑战性的临床医生，以确定它的可靠性，并认识到其对患者的临床轨迹的贡献。这项工作的目的是评估的可靠性，实时电子健康记录（EHR）审查使用的搜索策略，用于识别DE作为一个贡献者的快速反应小组（RRT）activation.ObjectivesEarly和准确的识别危重病是至关重要的。本研究的目的是测试的可行性和可靠性的前瞻性，实时EHR审查作为一种手段识别DE.MethodsWe进行了这项前瞻性观察性研究在2019年6月，包括连续的成年患者经历了他们的第一个RRT激活。根据文献和专家临床医生的输入，完善了EHR检索策略和标准操作程序。两名医生-研究者在RRT激活后24小时内独立审查合格患者EHR中的DE证据。在不一致的情况下，使用分类方法对EHR进行二次审查。评论者将DE的患者经历归类为是/否/Uncertain.ResultsWe回顾了112例患者的记录。两名审查员在15%的病例中发现DE。与初次审查的Kappa一致率为0.23，与二次审查的Kappa一致率为0.65。在60%的患者中未检测到DE证据。在25%的情况下，审查者无法确定是否DE存在或absent.ConclusionEHR审查是有限的价值，在住院患者的DE的实时识别。在这一领域的研究和质量改进工作需要采取其他办法。
BackgroundAlthough diagnostic error (DE) is a significant problem, it remains challenging for clinicians to identify it reliably and to recognize its contribution to the clinical trajectory of their patients. The purpose of this work was to evaluate the reliability of real-time electronic health record (EHR) reviews using a search strategy for the identification of DE as a contributor to the rapid response team (RRT) activation.ObjectivesEarly and accurate recognition of critical illness is of paramount importance. The objective of this study was to test the feasibility and reliability of prospective, real-time EHR reviews as a means of identification of DE.MethodsWe conducted this prospective observational study in June 2019 and included consecutive adult patients experiencing their first RRT activation. An EHR search strategy and a standard operating procedure were refined based on the literature and expert clinician inputs. Two physician-investigators independently reviewed eligible patient EHRs for the evidence of DE within 24 hours after RRT activation. In cases of disagreement, a secondary review of the EHR using a taxonomy approach was applied. The reviewers categorized patient experience of DE as Yes/No/Uncertain.ResultsWe reviewed 112 patient records. DE was identified in 15% of cases by both reviewers. Kappa agreement with the initial review was 0.23 and with the secondary review 0.65. No evidence of DE was detected in 60% of patients. In 25% of cases, the reviewers could not determine whether DE was present or absent.ConclusionEHR review is of limited value in the real-time identification of DE in hospitalized patients. Alternative approaches are needed for research and quality improvement efforts in this field.