Working Together to Improve Diagnosis: Day Three Recap

Today was the last day of our virtual conference: Working Together to Improve Diagnosis! Day Three had a Quality Improvement Focus.

KEYNOTE: FROM PRINCIPLE TO PRACTICE: HOW COMMUNICATION, PATIENT ENGAGEMENT, AND LEARNING CAN PREVENT AND RESPOND TO DIAGNOSTIC ERRORS

• Thomas Gallagher, MD, talked about how effective communication is the missing link to improving diagnosis. He illustrated this with patient video vignettes showing that transparent communication is harder than it looks. He stated that deep engagement of organizational leadership with injured patients and families is what drives prioritization of Communication and Resolution Programs (CRPs) and that the integration of concepts around improving diagnosis, high reliability and CRPs can substantially accelerate the progress of these critical and related areas.

FOLLOW-UP SYSTEM FAILURES: STOP DROPPING THE BALL

• Laurie Drill-Mellum, MD, MPH, reported that 43% of Constellation diagnosis-related malpractice claims originate in the outpatient setting and almost half involve high severity harm. Follow-up system failures contribute to over half of these claims so that even when the clinician starts on the correct path to a diagnosis, diagnostic errors still happen due to failures in systems, communications,  and care coordination.
• Andrew Olson, MD, told us that follow-up processes in the Emergency Department (ED) are usually evolved and not designed. Their quality improvement project at Lakewood Health System found  that follow-up processes were dependent on who was on call for the ED, not unlike most other hospitals.
• Missy Lindow of Lakewood Health System told us how they pulled together key stakeholders internally and from the community to map out their current state of ED follow-up processes. She says this was complex and painful, but to trust the process. The findings were important in identifying where they needed to look to improve.
• Mary Theurer, board member at Lakewood Health System, talked about how they worked to engage patients and the local community in the redesign of follow-up processes. They began with their patient and family advisory committee and then met with people from the community who accessed one of their programs. Dr. Olson then reminded the attendees that it is important to engage community stakeholders who match the demographics of who utilizes your ED.

TAKING ACTION TO CLOSE THE LOOP ON DIAGNOSTIC ERROR: A CONSTELLATION AND SIDM COLLABORATIVE

• Gerry Castro of the Society to Improve Diagnosis in Medicine (SIDM) recapped what were highlights for him from the entire virtual conference. He also discussed the common barriers to closing the loop on diagnosis and offered  guidance including designing the process with the patient and family at the center, minimizing unnecessary variations, minimizing the administrative burden and measuring the effectiveness of redesigned processes. He talked about Constellation and SIDM’s partnership, a virtual quality improvement collaborative, Taking Action to Close the Loop on Diagnostic Error. He announced that we’ve extended the deadline for clinics, hospitals and health systems to apply to June 30, 2021 giving organizations still dealing with COVID-19 time to submit their application.