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Jayaprakash N, Chae J, Sabov M, et al. Improving Diagnostic Fidelity: An Approach to Standardizing the Process in Patients With Emerging Critical Illness. Mayo Clin Proc Innov Qual Outcomes. 2019;3(3):327-334doi: 10.1016/j.mayocpiqo.2019.06.001.
Jayaprakash, N., Chae, J., Sabov, M., Samavedam, S., Gajic, O., & Pickering, B. W. (2019). Improving Diagnostic Fidelity: An Approach to Standardizing the Process in Patients With Emerging Critical Illness. Mayo Clinic proceedings. Innovations, quality & outcomes, 3(3), 327-334. https://doi.org/10.1016/j.mayocpiqo.2019.06.001
Jayaprakash, Namita, et al. "Improving Diagnostic Fidelity: An Approach to Standardizing the Process in Patients With Emerging Critical Illness." Mayo Clinic proceedings. Innovations, quality & outcomes vol. 3,3 (2019): 327-334. doi: https://doi.org/10.1016/j.mayocpiqo.2019.06.001
Jayaprakash N, Chae J, Sabov M, Samavedam S, Gajic O, Pickering BW. Improving Diagnostic Fidelity: An Approach to Standardizing the Process in Patients With Emerging Critical Illness. Mayo Clin Proc Innov Qual Outcomes. 2019 Jul 19;3(3):327-334. doi: 10.1016/j.mayocpiqo.2019.06.001. eCollection 2019 Sep. PMID: 31485571; PMCID: PMC6713917.
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Mayo Clin Proc Innov Qual Outcomes. 2019 Jul 19;3(3):327-334. doi: 10.1016/j.mayocpiqo.2019.06.001. eCollection 2019 Sep.

Improving Diagnostic Fidelity: An Approach to Standardizing the Process in Patients With Emerging Critical Illness.

Mayo Clinic proceedings. Innovations, quality & outcomes

Namita Jayaprakash, Junemee Chae, Moldovan Sabov, Sandhya Samavedam, Ognjen Gajic, Brian W Pickering

Affiliations

  1. Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI.
  2. Division of Pulmonary and Critical Care, Henry Ford Hospital, Detroit, MI.
  3. Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
  4. Department of Internal Medicine, Canton Medical Education Foundation, Canton, OH.
  5. Mercy Hospital, Springfield, MO.
  6. Department of Anesthesia and Critical Care, Mayo Clinic, Rochester, MN.

PMID: 31485571 PMCID: PMC6713917 DOI: 10.1016/j.mayocpiqo.2019.06.001

Abstract

OBJECTIVE: To reliably improve diagnostic fidelity and identify delays using a standardized approach applied to the electronic medical records of patients with emerging critical illness.

PATIENTS AND METHODS: This retrospective observational study at Mayo Clinic, Rochester, Minnesota, conducted June 1, 2016, to June 30, 2017, used a standard operating procedure applied to electronic medical records to identify variations in diagnostic fidelity and/or delay in adult patients with a rapid response team evaluation, at risk for critical illness. Multivariate logistic regression analysis identified predictors and compared outcomes for those with and without varying diagnostic fidelity and/or delay.

RESULTS: The sample included 130 patients. Median age was 65 years (interquartile range, 56-76 years), and 47.0% (52 of 130) were women. Clinically significant diagnostic error or delay was agreed in 23 (17.7%) patients (κ=0.57; 95% CI, 0.40-0.74). Median age was 65.4 years (interquartile range, 60.3-74.8) and 9 of the 23 (30.1%) were female. Of those with diagnostic error or delay, 60.9% (14 of 23) died in the hospital compared with 19.6% (21 of 107) without;

CONCLUSION: Diagnostic errors or delays can be reliably identified and are associated with higher comorbidity burden and increased mortality.

Keywords: APACHE III, Acute Physiology, Age, Chronic Health Evaluation III; ICU, intensive care unit; IOM, Institute of Medicine; IQR, interquartile range; RRT, rapid response team; SOP, standard operating procedure

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