Becker's Hospital Review

56 CMO / CARE DELIVERY 8 possible diagnostic errors related to COVID-19 By Mackenzie Bean T he COVID-19 pandemic could increase the risk of diagnostic errors due to staff- ing shortages, chaotic work environ- ments and high levels of clinician stress and fatigue, two healthcare quality experts wrote in an article published in the Journal of Hospital Medicine. e article's authors were: • Tejal Gandhi, MD, chief safety and trans- formation officer at Press Ganey Associates • Hardeep Singh, MD, chief of health policy, quality and informatics at the Michael E. DeBakey VA Medical Center in Houston. Drs. Gandhi and Singh identified eight diagnos- tic errors that may occur in the COVID-19 era based on emerging research and discussions with experts worldwide. e errors are defined below. 1. Classic: Missed or delayed COVID-19 diag- nosis in patients with respiratory symptoms. 2. Anomalous: Missed or delayed COVID-19 diagnosis in patients who do not have respira- tory symptoms. 3. Anchor: Missed or delayed diagnosis of a dif- ferent condition because clinicians assume the patient has COVID-19. 4. Secondary: Missed or delayed diagnosis of a secondary condition in a patient being treated for COVID-19. 5. Acute collateral: Delayed diagnosis of an acute condition because patients are not seek- ing care due to fear of contracting COVID-19 in a hospital or emergency department. 6. Chronic collateral: Delayed diagnosis of am- bulatory conditions due to canceled appoint- ments or elective procedures. 7. Strain: Missed or delayed diagnosis of a differ- ent condition because hospitals are overwhelmed, potentially limiting the time and attention clini- cians spend on non-COVID-19 patients. 8. Unintended: Missed or delayed diagnosis because clinicians are using telemedicine more instead of interacting with patients in person. n Direct COVID-19 patient care may not be main source of healthcare worker infections, 2 studies suggest By Anuja Vaidya W orking closely with COVID-19 patients may not be the primary cause of coronavirus infection among healthcare workers, two studies from China and the Netherlands found. The first study included data on 9,684 healthcare workers in Wuhan, China, collected from Jan. 1 to Feb. 9. It shows 110 workers contract- ed COVID-19. Researchers found that the infection rate was 0.5 percent among healthcare workers providing direct care to patients with con- firmed or suspected COVID-19 and 1.6 percent among healthcare work- ers in other clinical departments. Researchers also found that nurses younger than 45 years not directly car- ing for patients with COVID-19 were more likely to be infected, compared to physicians 45 years or older working directly with those patients. The second study examined 9,705 healthcare workers in two hospitals in the Netherlands during March. About 14 percent — 1,353 workers — reported fever or respiratory symptoms and were tested, of which 86 had COVID-19. Only about 3 percent of the healthcare workers with COVID-19 reported having been exposed to a hospital patient diag- nosed with the disease. Researchers concluded that the workers likely acquired the virus in the community during the early phase of the virus spreading locally. Both studies were published in JAMA Network Open. n 'Mass amnesia' of Spanish flu left world unprepared for COVID-19, scholars say By Mackenzie Bean T he Spanish flu upended the world in the early 20th century, yet the pandemic was largely absent from public discourse, literature, art or research in the coming decades, according to The New York Times. The 1918 flu pandemic sickened about 500 million people, or about one-third of the world's population at the time, according to the CDC. In the U.S., about 675,000 people died — more than all of the century's U.S. war casualties. However, there has been a "near total disappearance" of the pandemic in "society's collective memory," according to NYT. Some scholars argue this "mass amnesia" can, in part, explain why the world was so unprepared for the COVID-19 pandemic. It also helps explain why few memorials for the Spanish flu pandemic exist. "When I looked for memorials to the flu, I found nothing," Brian Zecchi- nelli, whose grandfather died in the pandemic, told NYT. "There was a plaque in Colorado and maybe something small in Australia, and that was it. I thought, 'This is crazy. This flu changed America forever. It changed the world forever.'" n

• Cover