Alvin Rajkomar

Improving diagnostic reasoning to improve patient safety.

Both clinicians and patients rely on an accurate diagnostic process to identify the correct illness and craft a treatment plan. Achieving improved diagnostic accuracy also fulfills organizational fiscal, safety, and legal objectives. It is frequently assumed that clinical experience and knowledge are sufficient to improve a clinicians diagnostic ability, but studies from fields where decision making and judgment are optimized suggest that additional effort beyond daily work is required for excellence. This article reviews the cognitive psychology of diagnostic reasoning and proposes steps that clinicians and health care systems can take to improve diagnostic accuracy.

Association Between Surgeon Scorecard Use and Operating Room Costs

Importance Despite the significant contribution of surgical spending to health care costs, most surgeons are unaware of their operating room costs. Objective To examine the association between providing surgeons with individualized cost feedback and surgical supply costs in the operating room. Design, Setting, and Participants The OR Surgical Cost Reduction (OR SCORE) project was a single–health system, multihospital, multidepartmental prospective controlled study in an urban academic setting. Intervention participants were attending surgeons in orthopedic surgery, otolaryngology–head and neck surgery, and neurological surgery (n = 63). Control participants were attending surgeons in cardiothoracic surgery, general surgery, vascular surgery, pediatric surgery, obstetrics/gynecology, ophthalmology, and urology (n = 186). Interventions From January 1 to December 31, 2015, each surgeon in the intervention group received standardized monthly scorecards showing the median surgical supply direct cost for each procedure type performed in the prior month compared with the surgeon’s baseline (July 1, 2012, to November 30, 2014) and compared with all surgeons at the institution performing the same procedure at baseline. All surgical departments were eligible for a financial incentive if they met a 5% cost reduction goal. Main Outcomes and Measures The primary outcome was each group’s median surgical supply cost per case. Secondary outcome measures included total departmental surgical supply costs, case mix index–adjusted median surgical supply costs, patient outcomes (30-day readmission, 30-day mortality, and discharge status), and surgeon responses to a postintervention study-specific health care value survey. Results The median surgical supply direct costs per case decreased 6.54% in the intervention group, from

Standardized attending rounds to improve the patient experience: A pragmatic cluster randomized controlled trial

1398 (interquartile range [IQR],

The association between discharge before noon and length of stay in medical and surgical patients.

316-

Using the Electronic Health Record to Identify Educational Gaps for Internal Medicine Interns

5181) (10 637 cases) in 2014 to

Using Spatial and Temporal Mapping to Identify Nosocomial Disease Transmission of Clostridium difficile

1307 (IQR,

Low Diagnostic Utility of Rechecking Hemoglobins Within 24 Hours in Hospitalized Patients

319-

Electronic Order Volume as a Meaningful Component in Estimating Patient Complexity and Resident Physician Workload

5037) (11 820 cases) in 2015. In contrast, the median surgical supply direct cost increased 7.42% in the control group, from

Next-generation audit and feedback for inpatient quality improvement using electronic health record data: a cluster randomised controlled trial

712 (IQR,

High-Throughput Classification of Radiographs Using Deep Convolutional Neural Networks

202-