The Recognizing Excellence in Diagnosis (REDx) initiative aims to reduce the risk of harm from diagnostic error, including the ED. In this project, the Leapfrog Group will partner with the Society to Improve Diagnosis in Medicine (SIDM) to identify best practices in ED diagnosis.

“We will encourage EDs nationally to adopt and use these in pursuit of diagnostic excellence,” says Mark L. Graber, MD, FACP, president emeritus of SIDM.

The initiative will establish a benchmarking system. This will allow EDs to find out how they compare to other EDs. “The ED is the first stop for patients with acute medical issues,” Graber notes.

Decisions on whether to admit, send home, or initiate a diagnostic workup in the ED are complex and error-prone. “Compared to other settings, there are many factors that add to the challenge in the ED,” Graber observes.

EPs do not know the patients and are seeing them at one point in time without a sense of the illness’s trajectory. There also is time pressure, past medical records are not always available, and distractions are constant. “Many high-harm diagnostic errors reflect delays in diagnosing acute conditions that present to the ED,” Graber says.

These include strokes, dissecting aneurysms, heart attacks, and acute infections. EDs have successfully diagnosed heart attacks, notes Graber, thanks in part to ECG guidelines for patients with suspected myocardial infarction (MI) and immediate availability of specialists. Many EDs are focused on the quality monitor “door-to-balloon time” (i.e., from first presentation to the ED to the time of angioplasty or bypass surgery) and are constantly seeking to improve it. “Adding all of this up, the management of patients with an MI is now both timely and highly accurate,” Graber says.

In contrast, says Graber, the error rates for many other vascular and infectious conditions are much higher, with no clear standards for timeliness. “This is where paying attention to the quality of care and improving diagnostic timeliness and accuracy could pay major dividends,” Graber says.