Screening for Missed Opportunities for Diagnosis in the ED Using eTriggers and Large Language Models

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Missed opportunities for diagnosis (MODs) are significant causes of patient harm in emergency departments (EDs).
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eTriggers are automated tools designed to identify patients at increased risk for MODs through focused record review.
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Large language models (LLMs) can assist in diagnostic safety reviews, but evidence of their effectiveness in real-world datasets is limited.
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The study evaluated LLMs using established ED eTrigger cohorts to compare their performance in identifying MODs.
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Independent reviews by emergency physicians were conducted to assess missed diagnosis opportunities based on electronic health records.

Jama Network Open

by Clifford M. Marks, Sean Gibney, Bryan Stenson, Deesha Sarma, Cynthia Gaudet, Haadi Mombini, Thomas A. Buckley, Mario Keko, Larry A. Nathanson, Laura G. Burke, Nathan I. Shapiro, Jonathan L. Burstein, Shamai A. Grossman, Anika Parab, Alexander T. Janke, Arjun K. Manrai, Richard A. Taylor, Carlo L. Rosen, Adam Rodman, Adrian D. Haimovich
June 29, 2026

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