Diagnosis最新文献_第9页

Features and functions of decision support systems for appropriate diagnostic imaging: a scoping review. 用于适当诊断成像的决策支持系统的特征和功能：范围界定综述。

IF 3.5

Diagnosis Pub Date : 2023-10-05 eCollection Date: 2024-02-01 DOI: 10.1515/dx-2023-0083

Fatemeh Rahimi, Reza Rabiei, Amir Saied Seddighi, Arash Roshanpoor, Afsoun Seddighi, Hamid Moghaddasi

{"title":"Features and functions of decision support systems for appropriate diagnostic imaging: a scoping review.","authors":"Fatemeh Rahimi, Reza Rabiei, Amir Saied Seddighi, Arash Roshanpoor, Afsoun Seddighi, Hamid Moghaddasi","doi":"10.1515/dx-2023-0083","DOIUrl":"10.1515/dx-2023-0083","url":null,"abstract":"Background: Diagnostic imaging decision support (DI-DS) systems could be effective tools for reducing inappropriate diagnostic imaging examinations. Since effective design and evaluation of these systems requires in-depth understanding of their features and functions, the present study aims to map the existing literature on DI-DS systems to identify features and functions of these systems.Methods: The search was performed using Scopus, Embase, PubMed, Web of Science, and Cochrane Central Registry of Controlled Trials (CENTRAL) and was limited to 2000 to 2021. Analytical studies, descriptive studies, reviews and book chapters that explicitly addressed the functions or features of DI-DS systems were included.Results: A total of 6,046 studies were identified. Out of these, 55 studies met the inclusion criteria. From these, 22 functions and 22 features were identified. Some of the identified features were: visibility, content chunking/grouping, deployed as a multidisciplinary program, clinically valid and relevant feedback, embedding current evidence, and targeted recommendations. And, some of the identified functions were: displaying an appropriateness score, recommending alternative or more appropriate imaging examination(s), providing recommendations for next diagnostic steps, and providing safety alerts.Conclusions: The set of features and functions obtained in the present study can provide a basis for developing well-designed DI-DS systems, which could help to improve adherence to diagnostic imaging guidelines, minimize unnecessary costs, and improve the outcome of care through appropriate diagnosis and on-time care delivery.","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":"4-16"},"PeriodicalIF":3.5,"publicationDate":"2023-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41119219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Error codes at autopsy to study potential biases in diagnostic error. 尸检中的错误代码，用于研究诊断错误中的潜在偏差。

IF 3.5

Diagnosis Pub Date : 2023-10-05 eCollection Date: 2023-11-01 DOI: 10.1515/dx-2023-0010

Bruce I Goldman, Rajnish Bharadwaj, Michelle Fuller, Tanzy Love, Leon Metlay, Caroline Dignan

{"title":"Error codes at autopsy to study potential biases in diagnostic error.","authors":"Bruce I Goldman, Rajnish Bharadwaj, Michelle Fuller, Tanzy Love, Leon Metlay, Caroline Dignan","doi":"10.1515/dx-2023-0010","DOIUrl":"10.1515/dx-2023-0010","url":null,"abstract":"Objectives: Current autopsy practice guidelines do not provide a mechanism to identify potential causes of diagnostic error (DE). We used our autopsy data registry to ask if gender or race were related to the frequency of diagnostic error found at autopsy.Methods: Our autopsy reports include International Classification of Diseases (ICD) 9 or ICD 10 diagnostic codes for major diagnoses as well as codes that identify types of error. From 2012 to mid-2015 only 2 codes were used: UNDOC (major undocumented diagnoses) and UNCON (major unconfirmed diagnoses). Major diagnoses contributed to death or would have been treated if known. Since mid-2015, codes included specific diagnoses, i.e. undiagnosed or unconfirmed myocardial infarction, infection, pulmonary thromboembolism, malignancy, or other diagnosis as well as cause of death. Adult autopsy cases from 2012 to 2019 were assessed for DE associated with reported sex or race (nonwhite or white). 528 cases were evaluated between 2012 and 2015 and 699 between 2015 and 2019.Results: Major DEs were identified at autopsy in 65.9 % of cases from 2012 to 2015 and in 72.1 % from 2015 to 2019. From 2012 to 2015, female autopsy cases showed a greater frequency in 4 parameters of DE, i.e., in the total number of cases with any error (p=0.0001), in the number of cases with UNDOC errors (p=0.0038) or UNCON errors (p=0.0006), and in the relative proportions of total numbers of errors (p=0.0001). From 2015 to 2019 undocumented malignancy was greater among males (p=0.0065); no other sex-related error was identified. In the same period some DE parameters were greater among nonwhite than among white subjects, including unconfirmed cause of death (p=0.035), and proportion of total error diagnoses (p=0.0003), UNCON diagnoses (p=0.0093), and UNDOC diagnoses (p=0.035).Conclusions: Coding for DE at autopsy can identify potential effects of biases on diagnostic error.","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":"375-382"},"PeriodicalIF":3.5,"publicationDate":"2023-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41116189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Enhancing clinical reasoning with Chat Generative Pre-trained Transformer: a practical guide. 使用Chat Generative预训练Transformer增强临床推理：实用指南。

IF 3.5

Diagnosis Pub Date : 2023-10-03 eCollection Date: 2024-02-01 DOI: 10.1515/dx-2023-0116

Takanobu Hirosawa, Taro Shimizu

{"title":"Enhancing clinical reasoning with Chat Generative Pre-trained Transformer: a practical guide.","authors":"Takanobu Hirosawa, Taro Shimizu","doi":"10.1515/dx-2023-0116","DOIUrl":"10.1515/dx-2023-0116","url":null,"abstract":"Objectives: This study aimed to elucidate effective methodologies for utilizing the generative artificial intelligence (AI) system, namely the Chat Generative Pre-trained Transformer (ChatGPT), in improving clinical reasoning abilities among clinicians.Methods: We conducted a comprehensive exploration of the capabilities of ChatGPT, emphasizing two main areas: (1) efficient utilization of ChatGPT, with a focus on application and language selection, input methodology, and output verification; and (2) specific strategies to bolster clinical reasoning using ChatGPT, including self-learning via simulated clinical case creation and engagement with published case reports.Results: Effective AI-based clinical reasoning development requires a clear delineation of both system roles and user needs. All outputs from the system necessitate rigorous verification against credible medical resources. When used in self-learning scenarios, capabilities of ChatGPT in clinical case creation notably enhanced disease comprehension.Conclusions: The efficient use of generative AIs, as exemplified by ChatGPT, can impressively enhance clinical reasoning among medical professionals. Adopting these cutting-edge tools promises a bright future for continuous advancements in clinicians' diagnostic skills, heralding a transformative era in digital healthcare.","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":"102-105"},"PeriodicalIF":3.5,"publicationDate":"2023-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41118516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

How do patients and care partners describe diagnostic uncertainty in an emergency department or urgent care setting? 患者和护理伙伴如何描述急诊科或紧急护理环境中的诊断不确定性？

IF 3.5

Diagnosis Pub Date : 2023-09-26 eCollection Date: 2024-02-01 DOI: 10.1515/dx-2023-0085

Athena P DeGennaro, Natalia Gonzalez, Susan Peterson, Kelly T Gleason

{"title":"How do patients and care partners describe diagnostic uncertainty in an emergency department or urgent care setting?","authors":"Athena P DeGennaro, Natalia Gonzalez, Susan Peterson, Kelly T Gleason","doi":"10.1515/dx-2023-0085","DOIUrl":"10.1515/dx-2023-0085","url":null,"abstract":"Objectives: Little is known about how patients perceive diagnostic uncertainty. We sought to understand how patients and care partners perceive uncertainty in an emergency or urgent care setting, where making a final diagnosis is often not possible.Methods: We administered a survey to a nationally representative panel on patient-reported diagnostic excellence in an emergency department or urgent care setting. The survey included items specific to perceived diagnostic excellence, visit characteristics, and demographics. We analyzed responses to two open-ended questions among those who reported uncertainty in the explanation they were given. Themes were identified using an inductive approach, and compared by whether respondents agreed or disagreed the explanation they were given was true.Results: Of the 1,116 respondents, 106 (10 %) reported that the care team was not certain in the explanation of their health problem. Five themes were identified in the open-ended responses: poor communication (73 %), uncertainty made transparent (10 %), incorrect information provided (9 %), inadequate testing equipment (4 %), and unable to determine (4 %). Of the respondents who reported uncertainty, 21 % (n=22/106) reported the explanation of their problem given was not true.Conclusions: The findings of this analysis suggest that the majority of patients and their care partners do not equate uncertainty with a wrong explanation of their health problem, and that poor communication was the most commonly cited reason for perceived uncertainty.","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":"97-101"},"PeriodicalIF":3.5,"publicationDate":"2023-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41157159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Routine blood test markers for predicting liver disease post HBV infection: precision pathology and pattern recognition. 预测HBV感染后肝病的血常规标志物：精确病理学和模式识别。

IF 3.5

Diagnosis Pub Date : 2023-09-20 eCollection Date: 2023-11-01 DOI: 10.1515/dx-2023-0078

Busayo I Ajuwon, Katrina Roper, Alice Richardson, Brett A Lidbury

{"title":"Routine blood test markers for predicting liver disease post HBV infection: precision pathology and pattern recognition.","authors":"Busayo I Ajuwon, Katrina Roper, Alice Richardson, Brett A Lidbury","doi":"10.1515/dx-2023-0078","DOIUrl":"10.1515/dx-2023-0078","url":null,"abstract":"Background: Early stages of hepatitis B virus (HBV) infection usually involve inflammation of the liver. Patients with chronic infection have an increased risk of progressive liver fibrosis, cirrhosis, and life-threatening clinical complications of end-stage hepatocellular carcinoma (HCC).Content: Early diagnosis of hepatic fibrosis and timely clinical management are critical to controlling disease progression and decreasing the burden of end-stage liver cancer. Fibrosis staging, through its current gold standard, liver biopsy, improves patient outcomes, but the clinical procedure is invasive with unpleasant post-procedural complications. Routine blood test markers offer promising diagnostic potential for early detection of liver disease without biopsy. There is a plethora of candidate routine blood test markers that have gone through phases of biomarker validation and have shown great promise, but their current limitations include a predictive ability that is limited to only a few stages of fibrosis. However, the advent of machine learning, notably pattern recognition, presents an opportunity to refine blood-based non-invasive models of hepatic fibrosis in the future.Summary: In this review, we highlight the current landscape of routine blood-based non-invasive models of hepatic fibrosis, and appraise the potential application of machine learning (pattern recognition) algorithms to refining these models and optimising clinical predictions of HBV-associated liver disease.Outlook: Machine learning via pattern recognition algorithms takes data analytics to a new realm, and offers the opportunity for enhanced multi-marker fibrosis stage prediction using pathology profile that leverages information across patient routine blood tests.","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":"337-347"},"PeriodicalIF":3.5,"publicationDate":"2023-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41126315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Diurnal temperature variation and the implications for diagnosis and infectious disease screening: a population-based study. 昼夜温度变化及其对诊断和传染病筛查的影响：一项基于人群的研究。

IF 3.5

Diagnosis Pub Date : 2023-09-13 eCollection Date: 2024-02-01 DOI: 10.1515/dx-2023-0074

Aaron C Miller, Scott H Koeneman, Manish Suneja, Joseph E Cavanaugh, Philip M Polgreen

{"title":"Diurnal temperature variation and the implications for diagnosis and infectious disease screening: a population-based study.","authors":"Aaron C Miller, Scott H Koeneman, Manish Suneja, Joseph E Cavanaugh, Philip M Polgreen","doi":"10.1515/dx-2023-0074","DOIUrl":"10.1515/dx-2023-0074","url":null,"abstract":"Objectives: Fevers have been used as a marker of disease for hundreds of years and are frequently used for disease screening. However, body temperature varies over the course of a day and across individual characteristics; such variation may limit the detection of febrile episodes complicating the diagnostic process. Our objective was to describe individual variation in diurnal temperature patterns during episodes of febrile activity using millions of recorded temperatures and evaluate the probability of recording a fever by sex and for different age groups.Methods: We use timestamped deidentified temperature readings from thermometers across the US to construct illness episodes where continuous periods of activity in a single user included a febrile reading. We model the mean temperature recorded and probability of registering a fever across the course of a day using sinusoidal regression models while accounting for user age and sex. We then estimate the probability of recording a fever by time of day for children, working-age adults, and older adults.Results: We find wide variation in body temperatures over the course of a day and across individual characteristics. The diurnal temperature pattern differed between men and women, and average temperatures declined for older age groups. The likelihood of detecting a fever varied widely by the time of day and by an individual's age or sex.Conclusions: Time of day and demographics should be considered when using body temperatures for diagnostic or screening purposes. Our results demonstrate the importance of follow-up thermometry readings if infectious diseases are suspected.","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":"54-62"},"PeriodicalIF":3.5,"publicationDate":"2023-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11005884/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10564632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Medical history-taking by highlighting the time course: PODCAST approach. 通过突出时间过程来采集病史：PODCAST 方法。

IF 3.5

Diagnosis Pub Date : 2023-09-08 eCollection Date: 2024-02-01 DOI: 10.1515/dx-2023-0101

Takahiro Kobayashi, Yosuke Ono

引用次数: 0

Effect of syringe underfilling on the quality of venous blood gas analysis. 注射器充气不足对静脉血气分析质量的影响。

IF 3.5

Diagnosis Pub Date : 2023-09-05 eCollection Date: 2024-02-01 DOI: 10.1515/dx-2023-0096

Giuseppe Lippi, Laura Pighi, Marco Tosi, Marco Vettori, Giovanni Celegon, Emmanuel J Favaloro, Gian Luca Salvagno

{"title":"Effect of syringe underfilling on the quality of venous blood gas analysis.","authors":"Giuseppe Lippi, Laura Pighi, Marco Tosi, Marco Vettori, Giovanni Celegon, Emmanuel J Favaloro, Gian Luca Salvagno","doi":"10.1515/dx-2023-0096","DOIUrl":"10.1515/dx-2023-0096","url":null,"abstract":"Objectives: There is limited information on the influence of collecting small amounts of blood on the quality of blood gas analysis. Therefore, the purpose of this study was to investigate the effects of different degrees of underfilling of syringes on test results of venous blood gas analysis.Methods: Venous blood was collected by venipuncture from 19 healthcare workers in three 1.0 mL syringes for blood gas analysis, by manually aspirating different volumes of blood (i.e., 1.0, 0.5 and 0.25 mL). Routine blood gas analysis was then immediately performed with GEM Premier 5,000. The results of the two underfilled syringes were compared with those of the reference syringe filled with appropriate blood volume.Results: The values of most assayed parameters did not differ significantly in the two underfilled syringes. Statistically significant variations were found for lactate, hematocrit and total hemoglobin, the values of which gradually increased as the fill volume diminished, as well as for sodium concentration, which decreased in both insufficiently filled blood gas syringes. The bias was clinically meaningful for lactate in syringe filled with 0.25 mL of blood, and for hematocrit, total hemoglobin and sodium in both syringes containing 0.5 and 0.25 mL of blood.Conclusions: Collection of smaller volumes of venous blood than the specified filling volume in blood gas syringes may have an effect on the quality of some test results, namely lactate, hematocrit, total hemoglobin and sodium. Specific indications must be given for standardizing the volume of blood to be collected within these syringes.","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":"91-96"},"PeriodicalIF":3.5,"publicationDate":"2023-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10137899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Diagnostic properties of natriuretic peptides and opportunities for personalized thresholds for detecting heart failure in primary care. 利钠肽的诊断特性和在初级保健中检测心力衰竭的个性化阈值的机会。

IF 3.5

Diagnosis Pub Date : 2023-09-05 eCollection Date: 2023-11-01 DOI: 10.1515/dx-2023-0089

Ralf E Harskamp, Lukas De Clercq, Lieke Veelers, Martijn C Schut, Henk C P M van Weert, M Louis Handoko, Eric P Moll van Charante, Jelle C L Himmelreich

{"title":"Diagnostic properties of natriuretic peptides and opportunities for personalized thresholds for detecting heart failure in primary care.","authors":"Ralf E Harskamp, Lukas De Clercq, Lieke Veelers, Martijn C Schut, Henk C P M van Weert, M Louis Handoko, Eric P Moll van Charante, Jelle C L Himmelreich","doi":"10.1515/dx-2023-0089","DOIUrl":"10.1515/dx-2023-0089","url":null,"abstract":"Objectives: Heart failure (HF) is a prevalent syndrome with considerable disease burden, healthcare utilization and costs. Timely diagnosis is essential to improve outcomes. This study aimed to compare the diagnostic performance of B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) in detecting HF in primary care. Our second aim was to explore if personalized thresholds (using age, sex, or other readily available parameters) would further improve diagnostic accuracy over universal thresholds.Methods: A retrospective study was performed among patients without prior HF who underwent natriuretic peptide (NP) testing in the Amsterdam General Practice Network between January 2011 and December 2021. HF incidence was based on registration out to 90 days after NP testing. Diagnostic accuracy was evaluated with AUROC, sensitivity and specificity based on guideline-recommended thresholds (125 ng/L for NT-proBNP and 35 ng/L for BNP). We used inverse probability of treatment weighting to adjust for confounding.Results: A total of 15,234 patients underwent NP testing, 6,870 with BNP (4.5 % had HF), and 8,364 with NT-proBNP (5.7 % had HF). NT-proBNP was more accurate than BNP, with an AUROC of 89.9 % (95 % CI: 88.4-91.2) vs. 85.9 % (95 % CI 83.5-88.2), with higher sensitivity (95.3 vs. 89.7 %) and specificity (59.1 vs. 58.0 %). Differentiating NP cut-off by clinical variables modestly improved diagnostic accuracy for BNP and NT-proBNP compared with a universal threshold.Conclusions: NT-proBNP outperforms BNP for detecting HF in primary care. Personalized instead of universal diagnostic thresholds led to modest improvement.","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":"432-439"},"PeriodicalIF":3.5,"publicationDate":"2023-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10526720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Scaling up a diagnostic pause at the ICU-to-ward transition: an exploration of barriers and facilitators to implementation of the ICU-PAUSE handoff tool. 在icu -病房过渡期间扩大诊断暂停:探索实施ICU-PAUSE切换工具的障碍和促进因素。

IF 3.5

Diagnosis Pub Date : 2023-08-21 eCollection Date: 2023-11-01 DOI: 10.1515/dx-2023-0046

Ella G Cornell, Emily Harris, Emma McCune, Elle Fukui, Patrick G Lyons, Juan C Rojas, Lekshmi Santhosh

{"title":"Scaling up a diagnostic pause at the ICU-to-ward transition: an exploration of barriers and facilitators to implementation of the ICU-PAUSE handoff tool.","authors":"Ella G Cornell, Emily Harris, Emma McCune, Elle Fukui, Patrick G Lyons, Juan C Rojas, Lekshmi Santhosh","doi":"10.1515/dx-2023-0046","DOIUrl":"10.1515/dx-2023-0046","url":null,"abstract":"Objectives: The transition from the intensive care unit (ICU) to the medical ward is a high-risk period due to medical complexity, reduced patient monitoring, and diagnostic uncertainty. Standardized handoff practices reduce errors associated with transitions of care, but little work has been done to standardize the ICU to ward handoff. Further, tools that exist do not focus on preventing diagnostic error. Using Human-Centered Design methods we previously created a novel EHR-based ICU-ward handoff tool (ICU-PAUSE) that embeds a diagnostic pause at the time of transfer. This study aims to explore barriers and facilitators to implementing a diagnostic pause at the ICU-to-ward transition.Methods: This is a multi-center qualitative study of semi-structured interviews with intensivists from ten academic medical centers. Interviews were analyzed iteratively through a grounded theory approach. The Sittig-Singh sociotechnical model was used as a unifying conceptual framework.Results: Across the eight domains of the model, we identified major benefits and barriers to implementation. The embedded pause to address diagnostic uncertainty was recognized as a key benefit. Participants agreed that standardization of verbal and written handoff would decrease variation in communication. The main barriers fell within the domains of workflow, institutional culture, people, and assessment.Conclusions: This study represents a novel application of the Sittig-Singh model in the assessment of a handoff tool. A unique feature of ICU-PAUSE is the explicit acknowledgement of diagnostic uncertainty, a practice that has been shown to reduce medical error and prevent premature closure. Results will be used to inform future multi-site implementation efforts.","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":"417-423"},"PeriodicalIF":3.5,"publicationDate":"2023-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10021918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0