A Customized Electronic Health Record-Based Tool Highlights and Addresses Gaps in Patient Safety.

The authors present a tool to improve gaps in patient safety using the electronic health record. The tool integrates gap identification, passive alerts, and actions into a single interface embedded within clinicians' workflow. The tool was developed to address venous thromboembolism prophylaxis, prevention of hypo- and hyperglycemia, code status documentation, bowel movement frequency, and skilled nursing facility transitions. Alerts and actions during silent and live periods were retrospectively analyzed. The most prevalent safety gaps were lack of venous thromboembolism prophylaxis (40.4% of alerts), constipation (19.3%), and lack of code status (18.4%). Disparities in safety gaps were present by patient race, sex, and socioeconomic status. Usability testing showed positive feedback without significant alert burden. Thus, a safety gap tool was successfully built to study and address patient safety issues. The tool's strengths are its integration within the electronic health record, ease of use, customizability, and scalability.

Using Cardiac Magnetic Resonance Imaging to Evaluate Patients with Chest Pain in the Emergency Department.

Chest pain is one of the most common presenting symptoms in the emergency department (ED). Among patients with abnormal troponins, it is imperative to quickly and accurately distinguish type 1 acute myocardial infarction (AMI) from other etiologies of myocardial injury. Although high-sensitivity troponin assays introduced a high negative predictive value for AMI, they have exposed the need for diagnostic modalities that can determine the etiology of acute myocardial injury. Cardiac magnetic resonance imaging (CMR) is an effective tool to risk stratifying chest pain among patients in the ED. CMR is non-invasive and has a lower cost of care and shorter length of stay compared to those of invasive coronary angiography. It also provides detailed information on cardiac morphology, function, tissue edema, and location and pattern of tissue damage that can help to differentiate many etiologies of cardiac injury. CMR is particularly useful to distinguish chest pain due to type 1 AMI versus supply-demand mismatch due to acute cardiac noncoronary artery disease. A detailed review of the literature has shown that CMR with stress testing is safe to use in patients presenting to the ED with chest pain, with or without abnormal troponins. CMR is a useful, safe, economical, and effective alternative to the traditional diagnostic tools that are typically used in this patient population. It is a practical tool to risk-stratify patients with possible cardiac pathology and to clarify diagnosis without invasive testing.