CODEX Digest 06.04.26

Contaminated blood cultures drive billions in annual US healthcare costs, but the pediatric burden is understudied. The results of this retrospective cohort study across outpatient, inpatient, and hospital settings find that contamination was linked to more emergency department visits, admissions, and longer stays, increasing costs and patient impact particularly in the outpatient setting.

A gap in pathology training regarding quality improvement and patient safety affects diagnostic safety. This study evaluates a structured curriculum aimed at enhancing pathology trainee competence and confidence. Its success in shifting attitudes and skills supports wider adoption in residency programs. Integrating such education nationally could promote a culture of safety and open error management in pathology.

Missed and delayed diagnoses are fundamental detractors from patient safety that too commonly affects minority populations. This 2025 Eisenberg Award-winning program describes Parkland Health's Safety Net Surveillance system, addressing diagnostic error inequities among underserved populations. By centralizing digital oversight, the program improved identification and management of missed or delayed diagnoses, offering a replicable blueprint for healthcare organizations to systematically reduce diagnostic errors and care disparities.

The transparency of AI decision content is heralded as important but its integration into clinical workflow may harbor unintended consequences. This mixed methods study looked at AI-supported diabetic retinopathy diagnosis, both with and without visual explanations (highlighting lesions). The visual explanations increased diagnostic time and decreased efficiency, showing how benefits of AI may actually decrease productivity when needed "human in loop" and transparency are incorporated.

Gender prejudice in medical education may affect student patient assessment and decision making. This Swiss study examines gender bias in male and female medical students' clinical reasoning for male and female standardized patients. Female patients were asked less about alcohol, work occupation, received fewer heart exams, and had increased prescription of lab tests. While the study didn't include non-binary or gender non conforming individuals, it is a provocative signal to how sexism pervades diagnostic care.

AI holds potential to optimize prostate cancer diagnostics, yet knowledge on how patients feel about these technologies is limited. This Norwegian qualitative study interviewed 18 men with low-grade prostate cancer, who ranged in educational background, employment, and age, about trust in AI-powered prostate cancer diagnostics. Findings reveal three themes: foundational trust in the healthcare system built from prior experience, interpersonal trust with professionals as the gateway to AI acceptance, and recognition of AI's diagnostic potential, tempered by concerns over accountability and AI's limited intuition.

To effectively reduce the potential for error, it is crucial to examine diagnostic process failures contextually rather than by single contributing factors. This Japanese cross-sectional study examines diagnostic errors linked to unexpected readmissions in general internal medicine, emphasizing the need to analyze recurring failure patterns rather than isolated factors. Two key weaknesses emerged: diagnostic prioritization and urgency appraisal and information acquisition and synthesis. Despite a small sample, identified patterns suggest targetable improvement areas applicable to similar outpatient settings.

Depression content on TikTok is often diagnostically incomplete across creator types, and engagement of young patients is apt to be driven more by style than accuracy. This quantitative content analysis findings illustrate concerns about the gradual broadening of depression examples and content on the social media platform that may support premature self-diagnosis. Diagnostic accuracy received an average score of 1 on a 0-4 scale.

Inappropriate imaging can cause unnecessary radiation, delayed diagnoses, and higher costs, yet sex-based disparities are understudied. In this German, multicenter, cluster-randomized trial, women were more likely than men to receive inappropriate imaging requests, suggesting disparities in diagnostic decision-making.

Diagnostic error occurrence in hospitalized sepsis patients has yet to be determined. This retrospective cohort study at 29 academic medical centers found that sepsis patients who died in the hospital or were admitted to the ICU had diagnostic error rates similar to those without sepsis. Using Safer Dx and DEER taxonomy, the authors found sepsis was less strongly associated with diagnostic error when history-taking or consultation gaps were present, suggesting these errors reflect broader care problems rather than sepsis-specific factors.

Systematic feedback may improve diagnostic performance in emergency departments (ED), though evidence is limited. This review looks at feedback characteristics provided to ED physicians and their impact on performance and confidence. Despite few low-quality studies, the findings suggest that structured feedback could positively influence ED physicians’ diagnostic abilities, highlighting its potential as a valuable enhancement tool.

AI is increasingly used in breast imaging, but successful adoption depends on radiologists’ trust and willingness to integrate it into practice. This commentary examines cognitive and system sources of diagnostic error and AI’s potential to support—and sometimes reshape—interpretation. The authors argue for context-sensitive implementation paired with ongoing education and bias awareness to improve accuracy while preserving radiologists’ critical judgment.