Publications by authors named "Alyssa Lam"
Background: Adverse event surveillance approaches underestimate the prevalence of harmful diagnostic errors (DEs) related to hospital care.
Methods: We conducted a single-centre, retrospective cohort study of a stratified sample of patients hospitalised on general medicine using four criteria: transfer to intensive care unit (ICU), death within 90 days, complex clinical events, and none of the aforementioned high-risk criteria. Cases in higher-risk subgroups were over-sampled in predefined percentages.
Objectives: This study aimed to pilot an application-based patient diagnostic questionnaire (PDQ) and assess the concordance of the admission diagnosis reported by the patient and entered by the clinician.
Methods: Eligible patients completed the PDQ assessing patients' understanding of and confidence in the diagnosis 24 hours into hospitalization either independently or with assistance. Demographic data, the hospital principal problem upon admission, and International Classification of Diseases 10th Revision (ICD-10) codes were retrieved from the electronic health record (EHR).
Objective: To describe a user-centered approach to develop, pilot test, and refine requirements for 3 electronic health record (EHR)-integrated interventions that target key diagnostic process failures in hospitalized patients.
Materials And Methods: Three interventions were prioritized for development: a Diagnostic Safety Column () within an EHR-integrated dashboard to identify at-risk patients; a Diagnostic Time-Out () for clinicians to reassess the working diagnosis; and a Patient Diagnosis Questionnaire () to gather patient concerns about the diagnostic process. Initial requirements were refined from analysis of test cases with elevated risk predicted by logic compared to risk perceived by a clinician working group; testing sessions with clinicians; responses from patients; and focus groups with clinicians and patient advisors using storyboarding to model the integrated interventions.
Objectives: To test a structured electronic health record (EHR) case review process to identify diagnostic errors (DE) and diagnostic process failures (DPFs) in acute care.
Methods: We adapted validated tools (Safer Dx, Diagnostic Error Evaluation Research [DEER] Taxonomy) to assess the diagnostic process during the hospital encounter and categorized 13 postulated e-triggers. We created two test cohorts of all preventable cases (n=28) and an equal number of randomly sampled non-preventable cases (n=28) from 365 adult general medicine patients who expired and underwent our institution's mortality case review process.