A Multi-Faceted Approach to Diagnostic Improvement
Society of Hospital Medicine
What follows is an interview with Benji Mathews, MD, FACP, SFHM, Chief of Hospital Medicine at Regions Hospital, Associate Professor through the University of Minnesota Medical School and Director of Point of Care Ultrasound for Hospital Medicine at Health Partners. He also serves on multiple committees within the Society of Hospital Medicine.
Why does the Society of Hospital Medicine (SHM) consider diagnostic quality an important issue?
The Society of Hospital Medicine represents more than 15,000 hospitalists in North America, a specialty that is rapidly growing. Hospitalists are physicians who specialize in the care of patients in the hospital. Training generally includes internal medicine, family medicine, and pediatrics.
SHM first began its efforts focused on Diagnostic Error in 2015, after the release of the IOM report, Improving Diagnosis in Health Care. “The supporting recommendations gave us an opportunity to start a dialogue about educating hospitalists regarding what diagnostic errors are and how to improve diagnosis,” Benji Mathews, MD, FACP, SFHM said.
It’s estimated that 40,000-80,000 deaths in U.S. hospitals annually are due to diagnostic error. “Hospitalists are on the front lines of care, so we need to be talking about diagnostic quality and safety,” said Dr. Mathews. “Addressing diagnostic quality requires enhancing teamwork and providing education and training to our members and beyond.”
Since the start of this interview, there have been many changes in the world with COVID-19. As frontline providers during the COVID-19 pandemic, SHM wants to offer clinicians as much support and information as possible to improve diagnosis. SHM has developed a toolkit that includes the most up-to-date information regarding COVID-19. This resource is continually updated with links from Centers for Disease Control & Prevention, webinars, publications, policy statements, and more.
Can you tell us a little more about SHM’s Diagnostic Error Subcommittee?
“The Diagnostic Error Subcommittee lives under the umbrella of SHM’s Hospital Quality and Patient Safety Committee, which develops educational, peer-reviewed maintenance of certification, or MOC modules,” Dr. Mathews explained.
The MOC modules were designed to familiarize hospitalists with strategies for avoiding common risk factors, such as inefficient teamwork and communication, that lead to diagnostic error. Through these modules, hospitalists become acquainted with techniques to minimize and mitigate risks that lead to diagnostic error during the handoff process, focus on deliberate practice and feedback, and learn how to integrate those strategies into the workflow.
“SHM members can access these modules anywhere—from their office, home, or via their mobile phone or tablet via the SHM Learning Portal,” said Dr. Mathews. “It gives us the opportunity to meet our members where they are.”
What other activities has SHM undertaken?
“At our national meeting, we hold sessions that support diagnostic quality and safety by exploring patient stories, explaining pitfalls and myths of diagnosis, discussing closing the loop with feedback/handoffs, hosting workshops, and more,” Dr. Mathews outlined. Additionally, there are sessions on improving communication and team-based care, improving health equity, and research innovations.
Outside of SHM’s conference, the organization’s Journal of Hospital Medicine showcases important perspectives in hospital medicine and clinical problem-solving cases. One example is an article that walks through the care of a 56-year old man who presented with shortness of breath, fever, and chills. It breaks down each step of the process, where it failed, and what can be learned from this case.
“SHM has led efforts around point-of-care ultrasound training,” said Dr. Mathews, who is a pioneer in bedside ultrasound. He has helped develop courses and teaches national programs to train frontline providers in the care of patients. There has been an increasing body of evidence that shows point-of-care ultrasound improves safety during medical procedures, aids diagnostic accuracy, and improves patient understanding of the diagnostic process.
For other organizations looking for best practices, Dr. Mathews recommends using more than one platform to engage the community. “Consider what is of value to your membership and audience. Provide online learning opportunities; social media engagement options; local, regional and national sessions or workshops and networking opportunities; and improve scholarship via projects and publications.”
With the recent news of the COVID-19 pandemic, SHM is aware that many of its frontline clinicians provide critical care services. To support its frontline workers to improve diagnostic patients safety and preparedness, SHM has shared several modules in the "Critical Care for the Hospitalist" series on the SHM Learning Portal that is especially relevant during the COVID-19 crisis, which is free for members and non-members.
What does success look like?
For SHM, success can be measured by the organization’s ability to support educational efforts and enhance awareness about diagnostic errors in the acute care setting. “We’re continuing to support diagnostic quality efforts in 2020 and beyond. Our Diagnostic Cases in Hospital Medicine module had 316 enrollments, 217 just in the past year,” Dr. Mathews said.
In the future, SHM leaders are hoping to identify funding for programs or the development of additional resources to engage hospitalists in improving diagnostic reasoning. They are hoping to shift into improved data sharing and developing electronic health record alerts to prevent diagnostic errors on the hospital floor.
“When it comes down to it, the ultimate measure of success is a reduction in diagnostic errors,” Dr. Mathews said. “But we need more awareness and engagement from teams on actionable projects for that to happen.”
“With the evolving outbreak of COVID-19, SHM is dedicated to supporting its frontline clinicians,” Dr. Mathews added. Dr. Mathews hopes to provide additional resources including regular updates to the SHM webpage for resources during the crisis. He also hopes to support clinicians through tools such as point of care ultrasound to provide a more timely, accurate explanation and guide management of a patient with the novel coronavirus. SHM will be continually updating its library of COVID-19 blogs, articles, publications, videos, and webinars from fellow frontline workers and thought leaders.
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