Patient Safety & Quality Improvement USMLE Step 1 Practice Question
A 52-year-old man with chest pain presents to the emergency department. His electrocardiogram shows nonspecific ST changes. A high-sensitivity troponin I is drawn and results at 0.8 ng/mL (normal <0.04 ng/mL), consistent with acute myocardial infarction. However, due to a laboratory information system error, the result is not transmitted to the electronic health record. The patient is discharged with a diagnosis of musculoskeletal chest pain. He presents 18 hours later with cardiogenic shock and receives an emergency coronary angioplasty. The hospital mortality and morbidity conference reviews this case as a serious adverse event. Which of the following quality improvement interventions would most effectively prevent recurrence of this type of error?
Answer choices
- AImplement a mandatory 4-hour continuing medical education module on troponin interpretation for all emergency department physicians
- BRequire the laboratory director to personally review all troponin results before transmission to the electronic health record
- CInstitute automated critical value alerts with simultaneous notification via multiple communication pathways (EHR alert, text message, and phone call) and mandatory physician acknowledgment requirementsCorrect answer
- DIncrease malpractice insurance coverage limits for the hospital and implement disciplinary action against the laboratory technician whose shift corresponded with the system malfunction
- EImplement a policy requiring all chest pain patients to receive troponin testing only after physician review of preliminary clinical assessment
- FRedesign the emergency department triage process to eliminate the use of troponin testing in favor of clinical judgment alone
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