An Operational Framework to Study Diagnostic Errors in Emergency Departments: Findings From A Consensus Panel

Area of Science:

• Emergency Medicine
• Patient Safety
• Healthcare Quality Improvement

Background:

• Diagnostic error is a significant concern in emergency departments.
• Existing frameworks for studying diagnostic error require adaptation for the emergency setting.

Purpose of the Study:

• To develop an operational definition for diagnostic error in emergency departments.
• To create a modified framework for studying diagnostic error in emergency care.

Main Methods:

• A multidisciplinary expert panel (17 members) was convened.
• A modified nominal group technique was employed.
• The National Academies of Sciences, Engineering, and Medicine's framework was adapted.

Main Results:

• Diagnostic error defined as "a divergence from evidence-based processes that increases the risk of poor outcomes despite the availability of sufficient information to provide a timely and accurate explanation of the patient's health problem(s)."
• Diagnostic processes encompass acuity recognition, information synthesis, evaluation, coordination, and communication.
• The framework was modified to include mode of arrival, triage level, and interventions.

Conclusions:

• The operational definition and framework can guide the development of measurement tools.
• This work supports research into the epidemiology of diagnostic error in emergency care.
• It facilitates the design of interventions to improve diagnostic accuracy and patient outcomes.