Implementation of an electronic health record e-trigger—based on the SPADE framework, which maps frequently missed diagnoses to one or more previously documented high-risk symptoms—helped identify missed diagnoses of stroke victims in an emergency department (ED), according to an AHRQ-funded study in the Journal of the American Medical Informatics Association. Diagnostic errors, especially in chaotic EDs, are a major contributor to patient harm. Researchers used the Safer Dx Trigger Tools Framework to develop the e-trigger to identify misdiagnosed stoke patients over a two-year period at 130 Veterans Affairs facilities. A review of 46,931 stroke-related admissions yielded 398 triggers for review. Of those, 124 cases (about 31 percent) had missed opportunities for diagnosis of stroke or transient ischemic attack. The findings suggested that a number of patients who presented with red flags and multiple stroke risk factors did not receive appropriate evaluation.
- Validation of an electronic trigger to measure missed diagnosis of stroke in emergency departments. Journal of the American Medical Informatics Association. July 19 2021