Assessing Performance of E-Triggers to Identify Diagnostic Errors in the ED

Background: Approximately 5% of outpatient adults experience diagnostic errors annually. Emergency departments (EDs) are considered high-risk settings due to their time-sensitive, severe, and fast-paced nature. Although numerous methods have been proposed for improvement, data are sparse and progress stagnant. Objective: To examine the performance of “Safer Dx Trigger Tools Framework” and e-triggers for identifying missed opportunities in diagnosis (MODs). Design: Retrospective record review. Methods: Treat-and-release ED visits across Veteran Affairs (VA) EDs from 2016 to 2020 were reviewed. Using the Safer Dx Trigger Tools Framework (see study for 7 steps), the authors developed 6 e-triggers in 4 categories: high-risk stroke, symptom-disease dyads, high-risk abdominal pain, unexpected ED return, unexpected hospital return, and abnormal test results not followed up after initial ED visit (positive blood/urine cultures or thyroid-stimulating hormone). Patients were exclud more...