Developing, pilot testing, and refining requirements for 3 EHR-integrated interventions to improve diagnostic safety in acute care: a user-centered approach.

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.

Analyzing diagnostic errors in the acute setting: a process-driven approach.

Objectives: We describe an approach for analyzing failures in diagnostic processes in a small, enriched cohort of general medicine patients who expired during hospitalization and experienced medical error. Our objective was to delineate a systematic strategy for identifying frequent and significant failures in the diagnostic process to inform strategies for preventing adverse events due to diagnostic error.

Methods: Two clinicians independently reviewed detailed records of purposively sampled cases identified from established institutional case review forums and assessed the likelihood of diagnostic error using the Safer Dx instrument.

Use, Perceived Usability, and Barriers to Implementation of a Patient Safety Dashboard Integrated within a Vendor EHR.

Background: Preventable adverse events continue to be a threat to hospitalized patients. Clinical decision support in the form of dashboards may improve compliance with evidence-based safety practices. However, limited research describes providers' experiences with dashboards integrated into vendor electronic health record (EHR) systems.