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

Document Type

Article

Publication Date

2019

Publication Title

Mayo Clin Proc Innov Qual Outcomes

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

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; P<.001. Diagnostic error or delay was associated with higher Charlson comorbidity index score, cardiac arrest triage score, and do not intubate/do not resuscitate status. Adjusting for age, do not intubate/do not resuscitate status, and Charlson comorbidity index score, diagnostic error or delay was associated with increased mortality; odds ratio, 5.7; 95% CI, 2.0-17.8. Conclusion: Diagnostic errors or delays can be reliably identified and are associated with higher comorbidity burden and increased mortality.

Medical Subject Headings

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

PubMed ID

31485571

ePublication

ePub ahead of print

Volume

3

Issue

3

First Page

327

Last Page

334

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