Background: Diagnostic errors (DE) – defined as incorrect, missed, or delayed diagnoses not made within a timeframe consistent with standard clinical practice – are common and can lead to harm, especially in acute care settings. One cause of DEs is suboptimal clinical reasoning in the diagnostic process. Electronic clinical documentation has been suggested to potentially [...]

Background: To date, attempts at estimating diagnostic error (DE), as defined as missed, incorrect, or delayed diagnoses, have focused on the identification of all types of adverse events, not specifically DE. Retrospectively identifying and ascertaining DE for hospitalized patients has been further challenged by (1) variability in operational definitions of DE; (2) use of non-standardized [...]

Background: The ordering of unnecessary daily labs affects the safety of patients through hospital-acquired anemia, patient discomfort, and unnecessary downstream testing. This results in both additional financial and labor costs burdening the health system. As such, establishing effective interventions is warranted with necessary analysis of site-specific lab-ordering culture. We seek to perform this analysis to [...]

Background: Low-value care in the form of overuse of inpatient diagnostic testing is an important driver of high healthcare costs. Financial incentives are known to impact physician behavior and may be a driver of inpatient diagnostic overuse. However, the association between hospital payer mix (which likely impacts the financial incentives for ordering diagnostic tests) and [...]

Background: Diagnostic errors are often attributed to cognitive and systems factors, including breakdowns in patient-clinician communication. The COVID-19 pandemic has limited this communication due to institutional infection control policies and physical distancing mandates, potentially increasing risk of diagnostic error. Virtually administered questionnaires that engage patients in assessing their experience with the diagnostic process have potential [...]

Background: The diagnostic process is fraught with diagnostic uncertainty. Typically, discussions about diagnostic uncertainty occur upon admission and during rounds, which are increasingly conducted virtually during the COVID-19 pandemic. Furthermore, key dimensions in the diagnostic process (history taking, physical examination, interpretation of diagnostic tests) are affected by breakdowns in communication between patients and clinicians, physical [...]

Background: Preclerkship medical education promotes the concept of clinical certainty through multiple choice testing and diagnostic reasoning curricula focused on System 1 thinking, namely illness scripts and pattern recognition (1). Clerkship medical education reinforces this concept via diagnosis driven didactic sessions and limited physician-led discussions of management uncertainty (2). Yet, clinical uncertainty is an inherent [...]

Case Presentation: 76 year old female with a history of COPD, Asthma, Allergic Rhinitis, and GERD presented to the Emergency Department for evaluation of worsening fatigue, dysgeusia and weight loss. Given these symptoms, the patient’s allergist referred her for COVID-19 testing. The patient denied any respiratory or GI symptoms, and review of symptoms was only [...]

Case Presentation: A 57-year-old male with history of C5-6 spinal cord injury (SCI) presented with recurrent episodes of sweating, flushing, headache, and hypertensive episodes over the past week, with concern for autonomic dysreflexia (AD). The patient is tetraplegic following traumatic SCI 38 years ago associated with remote episodic AD due to neurogenic bladder and adynamic [...]

Case Presentation: A 17-year-old female was transferred from an outside hospital for persistent cough, infiltrate on chest x-ray (CXR), and draining nodules on her legs and back. 1 month prior to transfer, she developed cough, shortness of breath, and malaise without fever. A CXR was consistent with pneumonia and doxycycline was initiated. 5 days later [...]