Unrecognized Cardiovascular Emergencies Among Medicare Patients

JAMA Internal Medicine
Daniel A WaxmanDavid L Schriger

Abstract

The Institute of Medicine described diagnostic error as the next frontier in patient safety and highlighted a critical need for better measurement tools. To estimate the proportions of emergency department (ED) visits attributable to symptoms of imminent ruptured abdominal aortic aneurysm (AAA), acute myocardial infarction (AMI), stroke, aortic dissection, and subarachnoid hemorrhage (SAH) that end in discharge without diagnosis; to evaluate longitudinal trends; and to identify patient characteristics independently associated with missed diagnostic opportunities. This was a retrospective cohort study of all Medicare claims for 2006 to 2014. The setting was hospital EDs in the United States. Participants included all fee-for-service Medicare patients admitted to the hospital during 2007 to 2014 for the conditions of interest. Hospice enrollees and patients with recent skilled nursing facility stays were excluded. The proportion of potential diagnostic opportunities missed in the ED was estimated using the difference between observed and expected ED discharges within 45 days of the index hospital admissions as the numerator, basing expected discharges on ED use by the same patients in earlier months. The denominator was estimated...Continue Reading

Citations

Jun 28, 2018·The New England Journal of Medicine·Jeffrey C KwongMichael A Campitelli
Apr 17, 2018·Emergency Medicine Australasia : EMA·Gerben KeijzersDaniel M Fatovich
Jun 29, 2018·The New England Journal of Medicine·Guillermo CuervoJordi Carratalà
Jun 16, 2018·Journal of the American College of Cardiology·Lars G Svensson
Jun 24, 2021·Vascular and Endovascular Surgery·Krystina ChoinskiJohn Phair
Dec 25, 2021·Radiographics : a Review Publication of the Radiological Society of North America, Inc·Kacie L SteinbrecherConstantine A Raptis

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