Coalition Member ACTions
Learn more about the individual actions members of the Coalition to Improve Diagnosis are taking to improve the diagnostic process.
ABIM Foundation supported national experts to develop a set of video learning modules to improve medical students and trainees’ diagnostic reasoning skills.
Through the Choosing Wisely campaign, the ABIM Foundation works with clinical and consumer partners to promote clinician-patient conversations about appropriate care and reduce the use of unnecessary tests, treatments and procedures. This effort helps reduce opportunities for overdiagnosis while ensuring patients get the care they need. The Foundation is launching an expanded Choosing Wisely learning network this spring to foster increased awareness and implementation, through a grant from the Robert Wood Johnson Foundation.
The Agency for Healthcare Research and Quality’s (AHRQ) Center for Quality Improvement and Patient Safety (CQuIPS) works to improve the quality and safety of the healthcare system through research and implementation of evidence. CQuIPS conducts and supports user-driven research on patient safety and healthcare quality measurement, reporting, and improvement.
AHRQ routinely includes patients and family members in the development of its products. The agency’s focus on broad strategies and its ongoing relationships with patients, clinicians, and researchers has led to widespread implementation of its products. The agency has hundreds of Impact Case Studies that detail what has been achieved with the use of its tools, resources, and data.
Read AHRQ's interview for ACT Update.
AAIM contributes to improving diagnosis by educating its members (11,000 faculty and staff in departments of internal medicine at medical schools and teaching hospitals) through conference programming at the APDIM Fall Meeting and Academic Internal Medicine Week.
AAFP provides evidence-based guidance to facilitate accurate and timely diagnoses through the development of clinical practice guidelines, preventive services recommendations, and the Choosing Wisely initiative. The AAFP recently released five new Choosing Wisely Recommendations aimed at reducing potentially unnecessary tests while providing patient-centered care through shared decision-making. AAFP journals and patient education site provide additional resources on to facilitate discussions on appropriate tests and treatments between patients and their family physicians.
AAP develops and supports a wide variety of resources related to accurate diagnosis in pediatric care. In addition to policy, the AAP provides a variety of opportunities for members to improve their knowledge and skills in preventing diagnostic errors. Their resources offer clinicians who care for children up-to-date, cutting edge information and tools to improve accurate diagnosis in pediatric populations, such as:
- Project RedDE!: A national improvement collaborative aimed at reducing the incidence of pediatric primary care diagnostic errors
- Risk management sessions focused on preventing diagnostic error
- Informational articles and webinars
- National Pediatric Readiness Project (partner)
- National Emergency Medical Services for Children Innovation & Improvement Center (EIIC; key stakeholder)
AACC launched LabTestsOnline.org in 2001 to help patients better understand the many clinical laboratory tests that play a critical role in diagnosing, monitoring, and treating a broad range of conditions, including cancer, diabetes, heart disease, and infectious diseases. Lab Tests Online content is peer-reviewed and available in 10+ languages through local sites around the globe.
AANP is educating its members on the importance of diagnostic accuracy and improved diagnosis. AANP is conducting an Educational Session at the 2019 AANP National Conference entitled “Reducing Diagnostic Errors in Practice: A Call to Action for Nurse Practitioners.”
By formalizing the requirement for training in recognition of diagnostic error and diagnostic accuracy, ABIM hopes to raise the profile of these important competencies within the curricula of Internal Medicine Graduate Medical Education.
ABIM will bring “recognizing diagnostic error and diagnostic accuracy” forward to the ABIM Internal Medicine Specialty Board, which oversees training requirements in Internal Medicine, for consideration for inclusion as a training requirement similar to the other six ACGME/ABMS core competencies and/or ABIM procedure requirements.
ABMS works in collaboration with its 24 member certifying boards to maintain the standards for physician certification and to improve the quality of healthcare to patients, families, and communities. The ABMS Member Boards community is involved in a broad spectrum of targeted efforts that support improvement in diagnosis including, formative assessment of knowledge and clinical judgment, lifelong-learning and self-assessment initiatives, directed learning activities, individual case and log reviews, and inter-professional and patient communications skill development.
In addition, the ABMS Continuing Certification Directory includes more than 30 learning activities devoted to improvement of diagnosis and reduction of diagnostic error. The Directory helps physician specialists meet their continuing certification requirements by participating in high-quality, practice-relevant, and ABMS Board-approved programs. ABMS also engages physicians in diagnostic improvement through annual conference sessions and supports research to improve diagnostic accuracy by early-career physician leaders participating in the ABMS Visiting Scholars Program.
ACEP created the Emergency Medicine Registry to compile quality initiatives of its members who treat over 140 million patients per year in the emergency department, as well as the E-QUAL learning collaborative which provides suggested guidelines in the diagnosis and treatment of emergency conditions including low back pain, opioid prescribing, chest pain, and sepsis. ACEP also participates in the Choosing Wisely initiative and has put forth 10 recommendations on how to diagnose and manage commonly encountered conditions.
For example, for pediatric head trauma, ACEP Choosing Wisely Recommendations promote using the PECARN Head Trauma Guidelines which emphasizes the history and examination with decreased use of CT imaging. ACEP has created a series of bedside point-of-care clinical tools to aid clinicians to promptly diagnose and treat emergency conditions including sepsis, complications of bariatric surgery, and acute pain. ACEP’s CME conferences are packed with sessions on accurately diagnosing the innumerable conditions that present to the emergency department in patients of all ages.
Expanding on the Leading for Safety initiative, the American College of Healthcare Executives and the Society to Improve Diagnosis in Medicine have partnered to create educational programming, including a complimentary webinar to be held in 2019 and a session at ACHE's 2020 Congress on Healthcare Leadership, that will provide healthcare leaders with the knowledge and actions they can take to improve diagnostic safety and quality in their organizations. ACHE’s goal is to educate healthcare leaders on:
- The impact and scope of the issue
- The roles that healthcare systems and processes play in achieving accurate, effective and timely diagnoses
- The tools, resources and best practices available to healthcare leaders and their teams to standardize and improve the diagnostic process
ACP’s goal is to help clinicians optimize their clinical decision-making skills to improve diagnostic accuracy in their daily care of patients. ACP has created and continues to develop resources to help clinicians better understand the diagnostic process and recognize the potential causes and consequences of misdiagnosis. Among the tools available are:
- A resource library available at acponline.org helps physicians improve diagnosis by helping them recognize and avoid common pitfalls.
- Interactive cases serve to encourage thinking around diagnostic decision-making, how problems may occur in that process, and how diagnostic errors may affect both their patients and them in their daily practice of medicine.
The ACGME implemented the Milestones in 2013 to help residency and fellowship programs improve curriculum and assessment in six Core Competencies. Based on lessons from the first five years of implementation, the ACGME has begun work on Milestones 2.0 for all specialties, which will occur from 2019 to 2022.
Recent data and research have raised awareness of the need to improve clinical and diagnostic reasoning in graduate medical education to reduce diagnostic error. The ACGME is using the Society to Improve Diagnosis in Medicine (SIDM) competency framework in diagnostic reasoning to guide all Milestones 2.0 Work Groups in their development of revised Medical Knowledge and Patient Care competencies. The ACT toolkit will also be included as part of the Supplemental Guide being developed for each Milestones 2.0 set.
The ACGME provides ongoing faculty development in assessment for graduate medical education programs in the United States and in other countries. The assessment of clinical and diagnostic reasoning is a core workshop in the Chicago-based six-day course. The workshop also covers the new SIDM competencies in diagnostic reasoning and the Assessment of Reasoning Tool. ACGME faculty members have partnered with Dr. Andrew Olson, one of the leaders in the development of the SIDM competency framework, to help teach the clinical reasoning workshop. The ACGME is also pursuing research in how developmental assessment like the Milestones and SIDM competencies can facilitate professional development in clinical and diagnostic reasoning.
Through the Choosing Wisely initiative, AHQA members strive to reduce unnecessary tests and treatments in healthcare and increase patient empowerment. Launched in 2012, Choosing Wisely is a leading effort to encourage conversations aimed at reducing unnecessary tests and treatments in healthcare. The mission of Choosing Wisely is to promote conversations between clinicians and patients by helping patients choose care that is supported by evidence, not duplicative of other tests or procedures already received, free from harm and truly necessary.
The American Society for Clinical Laboratory Science provides dynamic leadership and vigorously promotes all aspects of clinical laboratory science practice, education, and management to ensure excellent, accessible, and cost-effective laboratory services for healthcare consumers. The ASCLS formed the Patient Safety Committee, and together began educating its members about their role in patient safety. Staff then realized that laboratorians had been operating in a silo, and that errors were occurring due in part to a lack of understanding about the nuances of laboratory testing.
The ASCLS created educational brochures for patients and families to have the information necessary to have a meaningful conversation with their clinicians, and to teach people how to collect quality samples so that pre-analytical errors don’t impact the diagnosis. The organization developed content not only on appropriate testing, but also on factors that can negatively impact quality results and the correct interpretation of those tests. For example, some dietary supplements or prescriptions can interfere with laboratory testing methods and produce an erroneous result, which has the potential to end in a diagnostic error. To date, ASCLS has developed 14 brochures, all of which are available for download.
Read the ASCLS's interview for ACT Update.
ASHRM works with the Society to Improve Diagnosis in Medicine to examine and identify barriers to implementing quality improvement around diagnosis. ASHRM provides education programs to promote enterprise risk management, quality and patient safety. Learn more at www.ASHRM.org/education.
AAMC’s 10th Annual Integrating Quality Conference offered a plenary session and a workshop that addressed efforts to improve diagnosis in medicine. The plenary session led by Drs. Mark Graber and Andrew Olsen was attended by more than 250 healthcare professionals from 75 teaching hospitals and medical schools, and addressed a new team-based, inter-professional curriculum to improve diagnosis. In the workshop, facilitators led participants in role-play exercises to explore how to train healthcare professionals and patients to be effective team members in the diagnostic process.
ACS has several programs underway, including:
- A database with reporting tools that enable all AP personnel to provide feedback on all aspects of the process from specimen receipt through final reporting and billing. This database uses QA Tracker software to monitor a structured data set of 236 quality indicators in real time that can also be aggregated for review in a weekly management meeting to identify trends.
- A program of ‘handoffs and transitions’ to maximize communication and minimize errors in anatomic pathology specimen preparation and results reporting. Maximizing patient safety through clear communication is a top priority in any healthcare setting.
- Reports to speed up and improve referral processes in rheumatology at Harris Health. Reports are placed in the patients’ charts and communicated to primary care providers via electronic messages to their personal baskets. Results include increased patient satisfaction and fewer unnecessary tests.
- An elective 20-hour course to medical students on how to use the clinical laboratory. The aim of the course has been to show them how to properly select laboratory tests and understand how to interpret the results.
- A Molecular Tumor Board (MTB) for patient selection and assessment of treatment options. Results suggest that their detection of actionable mutations may be higher due to their careful selection, allowing the focused selection of treatment modalities.
- A review of the potential errors in point-of-care testing (POCT) that may have adverse effects to patients that are associated with patients’ healthcare.
- An implementation of eight different stages of automation and 16 separate process improvements or engineering controls that has reduced the incidence of lost specimens nearly 100-fold.
- A standardization of anatomic pathology reports and automation of grossing templates for common submitted samples.
- An experiment to prove how problematic interpreting laboratory reports, particularly molecular data, can be.
- Inter-professional simulations that allow for students and professionals from many backgrounds to practice teamwork and communication, designed by experts at the University of Alabama.
Baystate Health has made Diagnostic Excellence a major priority of their comprehensive Patient Safety program. They are committed to identifying opportunities to improve the diagnostic process and to implement solutions that will reduce harm from misdiagnosis. In order to achieve that goal, they have organized interdisciplinary teams to study and act in many areas including clinical reasoning education, incident identification and review, electronic clinical decision support, quality improvement activities, and clinical pathway development. Some recent examples:
- Use of a tailored diagnostic error review tool for Root Cause Analysis
- Implementation of a standardized Spinal Epidural Abscess diagnostic algorithm
- Development and implementation of a Diagnostic Errors Reporting System in Hospital Medicine
- Defined Clinical Reasoning curriculum and prioritized in medical school and residency education
- Engagement of Patient and Family Advisory Council in partnering with us to educate patients broadly on the diagnostic process and improvement efforts
Children’s Hospital Association helps children’s hospitals reduce patient harm by advancing diagnostic safety through data-driven collaboratives focused on areas of greatest impact, such as patient safety practices and hospital onset of severe sepsis:
Child Health PSO is certified by the Agency for Healthcare Research and Quality (AHRQ) to provide federal privilege and confidentiality protections to the safety event reporting and shared learning of 63 children’s hospitals who are focused on the elimination of preventable pediatric patient harm. Their collective data has revealed an urgent need to improve diagnostic safety. They have been collaborating to understand vulnerabilities and actions to implement to mitigate harm, and will soon release a tool highlighting pivotal points of communication in the diagnostic process.
Improving Pediatric Sepsis Outcomes (IPSO), a collaborative of 56 hospitals, is designed to improve pediatric sepsis outcomes through early recognition and diagnosis coupled with timely treatment. The program emphasizes cross-disciplinary communication and collaboration and engages staff throughout the hospital by promoting seven clinical bundles that promote standardization of recognition, diagnosis, and treatment of sepsis. The program goal is to reduce hospital onset of severe sepsis by 25% and reduce sepsis mortality by 25%.
CHOP has been educating their clinical staff for several years about cognitive bias, and with their “Cognitive Bias Think Tank” they continue to expand the inclusion of this topic in their safety work. They are fostering increased attention to the risk of diagnostic error that arises through the ways in which clinicians think about and interpret data about patients.
CAPS is collaborating with Compass HIIN to create a change packet regarding the laboratory’s role in diagnostic error. The change packet will provide actionable initiatives for hospitals of all sizes to implement and improve the diagnostic process within their facility.
CMSS will convene a CMSS Task Force across their 43 member specialty societies to share best practices and identify collaborative opportunities to address timely and accurate diagnosis. Their goal is to encourage greater focus and collaborative efforts to improve diagnosis across specialty societies.
ECRI Institute’s Partnership for Health IT Patient Safety developed a set of solutions, all of which are available free of charge. “Health IT Safe Practices for Closing the Loop,” not only addresses the consequences of failing to close the loop but provides safe practice recommendations and implementation strategies for health IT stakeholders. A podcast series features members of the Partnership’s Expert Advisory Panel. Materials are available online at: www.ecri.org/safepractices.
Geisinger convened a multidisciplinary group of clinical leaders and staff to address the challenge of diagnostic errors. The group known as the “Committee to Improve Clinical Diagnosis” has an extensive agenda but seeks to identify and assess diagnostic errors while making every error an opportunity for broad-based learning through an open and constructive process.
IHI will be hosting three sessions related to diagnostic error during the annual IHI Forum in December 2018: “Reducing Diagnostic Errors: A Practical Workshop,” “Reducing Diagnostic Errors in Clinical Settings,” and “Improving Value; Putting a Strategic Focus on Overdiagnosis.” Additionally, they plan to host sessions on diagnostic error and accuracy at the 2019 IHI Annual Patient Safety Congress.
IHI also created a learning collaborative. Diagnostic error remains an important and unaddressed problem in all care settings. We therefore know where to focus improvement efforts, and why, but not how. This completed work advances a plan to break this cycle of inaction by enabling pioneering healthcare organizations to begin experimenting with interventions and evaluating their relative merits and impact.
- IHI WIHI (February 2018): Practicing More Careful and Thoughtful Diagnosis
- IHI/NPSF (2017): Closing the Loop: A Guide to Safer Ambulatory Referrals in the EHR Era 2017
- IHI WIHI (December 2015): Harnessing Improvement to Reduce Diagnostic Errors and Delays
- IHI WIHI (January 2016) Diagnosis Is a Process: Experts Offer Advice on Diagnostic Error and Delays in Patient Safety
As a learning health system committed to continuous improvement, we are emphasizing communication, shared learning and systems improvement around diagnostic safety. We have expanded our safety event program to enhance the collection of data about opportunities to improve the diagnostic process. Our aim is to support our teams in doing some of the most fundamental work in healthcare: making an accurate and timely diagnosis, with the promise of reducing harm and improving health outcomes.
Read Intermountain Healthcare's interview for ACT Update.
The Armstrong Institute Center for Diagnostic Excellence at Johns Hopkins provides a unique, collaborative, transdisciplinary environment for clinicians, researchers, engineers and data experts to work together to improve diagnosis and eliminate patient harms from misdiagnosis. Our focus is on scalable solutions to eliminate serious harms from “the Big Three” (vascular events, infections, and cancer) by leveraging teamwork, training, technology, and tuning to transform diagnosis.
The Southern California Permanente Medical Group (SCPMG) developed SureNet under the leadership of Dr. Michael Kanter, now Chair of Clinical Sciences at the Kaiser Permanente School of Medicine. SureNet is a program that uses Kaiser Permanente’s robust electronic health record data to identify patients with test results or symptoms/signs that generally require a next step or follow-up, and flags when the patients haven’t received it. SureNet has been so successful that other organizations like Brigham and Women’s Hospital have partnered with Kaiser Permanente to develop similar programs. There are now more than 50 programs within the SureNets of Kaiser Permanente regions nationwide.
Read Kaiser Permanente's interview for ACT Update.
The Maryland Patient Safety Center, a not-for-profit organization committed to improving patient safety in the state and region of Maryland, facilitates an inter-disciplinary and multi-organization advisory council working to develop strategies to improve diagnosis. Through these efforts they are committed to the goal of reducing harm from diagnostic errors. The Maryland Patient Safety Center is focused on developing a database that will be useful in exploring potential diagnostic errors and in educating healthcare workers on the issue.
The Massachusetts Coalition shares studies, resources and presentations of initiatives at their membership meetings. They participate in local collaborations including the PRIDE initiative, to develop and share case studies. They have offered three strategies to test in office practices using a quality improvement approach:
- Partnering with patients to improve follow-up if treatment doesn’t produce expected results;
- Stalling premature closure (“What else could it be?”); and
- Mitigating confirmation bias (“What data don’t fit?”).
They encourage providers to test and share their results. Their continuing approach is to raise awareness of the level of harm and factors contributing to diagnostic errors, and to promote identification and broader adoption of effective strategies in the state through sharing among members and with national organizations.
At the Coalition’s 2019 Annual Patient Safety Forum, there were several presentations on improving the diagnostic process in both the inpatient and ambulatory setting (available at http://macoalition.org/patient-safety-forum-4-2019.shtml) . The Coalition also featured a presentation on the PRIDE initiative at its June 2019 membership meeting.
Diagnosis-related errors are among the most frequently named causes of action in medical professional liability (MPL) claims. The MPL Association strives to reduce diagnosis-related claims, and through its Data Sharing Project engages in ongoing analyses of diagnosis-related issues as identified in MPL claims data. As a result of this work, the MPL Association develops educational programs and other learning materials to educate MPL insurers and their policyholders (physicians, dentists, hospitals, clinics, and other healthcare providers) about diagnostic errors and associated issues, and also provides guidance to help mitigate diagnosis-related risk.
The MedStar Center for Improving Diagnosis in Healthcare is focused on:
- Convening interested clinician, patient and family, and community stakeholders;
- Collaborating to identify and prioritize diagnostic challenges;
- Creating goal-directed strategies and tactics, training, tools and effective improvement interventions; and
- Communicating what they learn with the larger healthcare community through workshops, publications, enhanced training and expanded research.
A number of related incubator processes are currently underway across MedStar, including a clinical reasoning program for medical residents focused on diagnosis, surveys of providers and administrative leaders to identify gaps in awareness and knowledge about diagnostic error and to understand perceptions related to the magnitude of diagnostic issues in the healthcare environment.
The MedStar Health Institute for Quality and Safety (MIQS) faculty and staff are also gathering insights from important MedStar programs such as We Want to Know and Learning from Every Death to quantify how often problems or concerns related to diagnosis are identified. MedStar also has one of six teams from across the nation selected to participate in a prototyping diagnosis improvement collaborative funded by the Gordon & Betty Moore Foundation and organized and led by the Society to Improve Diagnosis in Medicine and the Institute for Healthcare Improvement.
MAPS hosted a webinar on July 16, 2019 featuring Paul Epner focused on the “MAPS Top 10 Patient Safety Issues for 2019” highlighting Diagnostic Error and Missed Opportunities. A preview of the white paper can be found here: https://www.alliance4ptsafety.org/MAPS-PSO/Purchase-whitepaper.aspx
NAPNAP continues to provide education to its members, who are pediatric-focused advanced practice registered nurses (APRNs) to understand possible personal, system, and patient contributions to diagnostic errors and strategies to improve patient-centered diagnostic outcomes.
In addition to developing a general framework for measurement of diagnostic quality and safety, NQF is launching a project that aims to develop a framework for chief complaint-based measurement in the emergency department. The goal of the Chief Complaint-Based Quality of Emergency Care project is to lay the conceptual groundwork for measurement approaches that capture the important role of chief complaints in the diagnosis and treatment of patients presenting to the emergency department.
Northwell Health has instituted a teach-back method that instructs providers to go a step further by asking patients to explain the diagnosis back to them. By asking patients to explain the diagnosis, patients often ask another question, clarify information, or remember a piece of medical history that they hadn’t before.
Additionally, Northwell has another project underway where, through education and training, they are teaching physicians how to identify and care for patients who may be at risk of long-term cardiovascular disease.
Read Northwell Health's interview for ACT Update.
The PCPCC's mission is to make primary care more robust and patient-centered through advocacy/policy efforts focused on care delivery and payment reforms, including the Patient-Centered Medical Home (PCMH). Such models seek to achieve the vision embodied in the Shared Principles of Primary Care, where primary care is more comprehensive, coordinated, integrated and continuous—which would contribute to improved diagnostic accuracy. An enhanced relationship between patients and primary care clinicians is foundational to better health.
Penn State Health is developing a work flow called Reducing Diagnostic Error in Radiology Resident Reports for Trauma Patients, where it performs 100% audits of all emergency room traumas imaging examinations to determine discrepancies between overnight radiology resident preliminary and final attending subspecialty radiology reports. The reports use natural language processing to identify discrepancies between the two reports and have a standardized scoring system to rate the clinical significance of the discrepancy and failure mode (perception error, knowledge error, communication error, etc.).
For the patients with a clinically significant discrepancy, Penn State Health will perform follow up chart reviews at 24 hours, 30 days, and 60 days to determine if there was patient harm. It will evaluate for trends in errors and use that information to develop e-learning content for residents. With this work flow they plan to:
- Reduce clinically significant discrepancies between the overnight interpretation provided by the radiology resident and the subspecialty trained radiologist to less than the national discrepancy rate between practicing radiologists (1.8%);
- Reduce harm to trauma patients undergoing diagnostic imaging; and
- Improve training of diagnostic radiology residents by targeted intervention on errors made while providing on-call interpretations of trauma studies and rapid feedback on resident diagnostic performance.
The Pennsylvania Patient Safety Authority has established a Center of Excellence for Improving Diagnosis to provide leadership, guidance, and support for healthcare facilities and systems, providers, patients, and all interested stakeholders. The Center will gather, synthesize, and share information to broaden awareness and understanding; build partnerships and create new networks to accelerate and scale improvement efforts; and facilitate the development and implementation of novel solutions to improve diagnosis throughout Pennsylvania and beyond.
Kaiser Permanente’s Surenet program addresses the challenge of missed or delayed diagnosis through the use of an electronic “safety net” integrated with the electronic health record. The automated program scans the EHR to identify potential patient safety issues ranging from drug-disease interaction to delay in follow up on abnormal test results. The goal is to support the care team to initiate appropriate follow-up care, help improve diagnosis, monitor program effectiveness and reduce incidence of harm. Systematic surveillance of KP HealthConnect data through SureNet has reduced outpatient risks, led to earlier diagnosis and detection, and improved medication safety. Currently, there are 29 Diagnostics Detection programs and 25 Medication Safety programs across Kaiser Permanente.
Sepsis Alliance launched Sepsis: It’s About T.I.M.E™, a national multimedia initiative to raise awareness of the signs and symptoms of sepsis and the urgent need for treatment when symptoms are recognized. The T.I.M.E acronym stands for (1) Temperature – Higher or lower than normal, (2) Infection – May have signs and symptoms of an infection, (3) Mental decline – Confused, sleepy, difficult to rouse, (4) Extremely ill – “I feel like I might die,” severe pain or discomfort. Sepsis Alliance also offers webinars and training modules to healthcare providers to improve sepsis diagnosis and patient outcomes.
Read Sepsis Alliance's interview for ACT Update.
The Society of Bedside Medicine has a program called Improving Bedside Clinical Exam Skills to Reduce Diagnostic Error. In addition to emphasizing traditional physical examination skills, the Society of Bedside Medicine incorporates point-of-care technology such as bedside ultrasound to improve the teaching and practice of bedside skills.
By improving overall clinical exam skills, they expect to improve diagnostic accuracy, decrease cost of care, and improve patient and provider satisfaction with the clinical encounter. They also expect that by empowering their learners with better clinical exam skills, they will spend more time at the bedside engaging in shared discovery with patients, as well as teaching other learners. The Society of Bedside Medicine provides its members with teaching tools to enhance the bedside physical exam skills of learners. At their annual meeting, they will provide members with an opportunity to participate in a U.K.-style assessment of clinical exam skills, with the goal of providing members the skills needed to start their own physical diagnosis teaching and assessment programs at their home institutions.
To address diagnostic error in hospital medicine, SHM’s Hospital Quality and Patient Safety Committee launched the Reducing Diagnostic Error Subcommittee charged with developing strategies, ideas, and resources to address diagnostic error in hospital medicine. In 2017, the subcommittee partnered with SIDM to develop an online CME/MOC learning module that defines and outlines best practices in the realm of diagnostic error as it relates to teamwork, handoffs, incidental findings, and feedback. The module is set to go live in the SHM Learning Portal by Fall 2018 and will be available to SHM and SIDM members free of charge. Participants learn how to:
- Apply TeamSTEPPS language of escalation using “CUS” (I am Concerned, I am Uncomfortable, This is a Safety issue) words
- Describe how the cognitive bias can lead to misdiagnosis
- Explain how TeamSTEPPS practice of “check-back” can aid in patient understanding
- Apply the TeamSTEPPS approach in creating a safe discharge plan
- Understand the role of cognitive bias in perpetuating diagnostic errors during handovers
- Identify patients at high risk for diagnostic errors during handovers
- Describe strategies used to avoid diagnostic errors during handovers
- Recognize how communication failure contributes to diagnostic errors
- Identify how failure to follow up on test results could lead to diagnostic error
- To develop strategies for feedback and its integration into everyday workflow.
For SHM's annual meeting in 2019, there is a diagnostic reasoning track with topics including Stump the Professor, pitfalls and myths in diagnosis, and a presentation of how hospitalists make diagnoses.
The Society to Improve Diagnosis in Medicine catalyzes and leads change to improve diagnosis and eliminate harm from diagnostic error. They work in partnership with patients, their families, the healthcare community, and every interested stakeholder. SIDM is the only organization focused solely on the problem of diagnostic error and improving the accuracy and timeliness of diagnosis. Among their activities:
DEM2018: Innovating to Improve Diagnosis
The Diagnostic Error in Medicine 11th Annual International Conference took place in New Orleans, LA, November 4-6, 2018 at the Hyatt Regency.
The Conference brought together physicians, patients, nurses, healthcare professionals, researchers, institutional leaders and policymakers to showcase and share recent innovations to reduce error and improve the diagnostic process. The 2015 National Academy of Medicine report Improving Diagnosis in Healthcare recommended developing and deploying approaches to identify, learn from, and reduce diagnostic errors and near misses in clinical practice. Our 2018 conference focused on this recommendation.
The DEM2018 theme was Innovating to Improve Diagnosis, offering cutting edge topics for learning and discussion.
Training the Next Generation
- Clinical Reasoning Toolkit – Diagnostic reasoning is fundamental for any clinician. Access resources that will help you improve your clinical reasoning.
- Assessment of Reasoning Tool (ART) – Use SIDM's Assessment of Reasoning Tool to assess a learner’s clinical reasoning skills and move toward improving diagnosis.
- SIDM Diagnostic Medicine Fellowship – The Society to Improve Diagnosis in Medicine offers an annual fellowship for healthcare professionals with an interest in improving diagnostic safety and quality. SIDM will match you with experienced mentors who are recognized leaders in the fields of diagnostic error education, research, or practice improvement.
Engaging the Community
- Journal Club – Join researchers in the field to discuss new and emerging research in the area of diagnosis. Journal Club meets a few times a year.
- ImproveDX Newsletter – Learn about developments from the field with original educational articles and with news about SIDM's activities.
- Resources for Researchers – Explore existing literature, engage with your peers, and join the conversation as we work to foster the growth of the diagnostic error research community.
- Patient Toolkit for Diagnosis – The Patient's Toolkit for Diagnosis is created for people who are not feeling well or are visiting their doctor or nurse with a health concern. As patients, we have found that taking an active role in our care can help our doctors and nurses figure out a good “working” diagnosis. Not all diagnoses are correct, which is why we say “working” diagnosis. A diagnosis may be certain or uncertain, and making a diagnosis could be easy or difficult.
- Sharing Stories – We are collecting stories from patients who have experienced a wrong, delayed or missed diagnosis. Share your story with us.
- Diagnosis – Diagnosis is an exciting benefit for SIDM Members only. We are happy to offer our new and existing members free access to the only influential medical journal focused on all aspects of diagnosis in medicine. Diagnosis, published by De Gruyter, is now the official peer-reviewed journal of the Society to Improve Diagnosis in Medicine.
Developing Effective Tools to Improve the Diagnostic Process
Working with the Institute for Healthcare Improvement (IHI), SIDM and a number of healthcare organizations have developed a collaborative to test and develop tools and techniques to improve the safety of the diagnostic process. With funding from the Gordon & Betty Moore Foundation and using the IHI Model for Improvement which works to accelerate improvement by establishing three fundamental questions: 1) What are we trying to accomplish? 2) How will we know that a change is an improvement? 3) What change can we make that will result in improvement?—and then using a Plan-Do-Study-Act (PDSA) cycle to test implementation in real world settings. The SIDM/IHI collaborative includes six pilot sites: MedStar Health, University of Michigan, Nationwide Children’s Hospital, Tufts Medical Center, Northwell Health and the UCSF Medical Center. At the end of the project SIDM and IHI will evaluate the relative merits and impact of each of the pilots and develop a dissemination plan for successful interventions.
Increasing Research Funding to Improve Diagnostic Quality and Safety
Federal investment in research to understand the many causes of diagnostic error and solutions to improve diagnostic safety has totaled only a few million dollars per year; as a result, the science of diagnostic safety and quality is underdeveloped, and many known potential solutions have not yet been tested or confirmed in actual clinical practice.
In 2015 the National Academy of Medicine strongly recommended dedicated federal funding to support a robust pipeline of diagnostic research and inter-agency coordination of research efforts. The Society to Improve Diagnosis in Medicine has made building support for increased research funding a strategic priority. Efforts around this initiative include a Consensus Statement signed by members of the Coalition to Improve Diagnosis in support increased federal funding for research and a Roadmap for Policy Action that describes the kinds of research that are needed and the steps that policymakers, stakeholders and others can take to turn the NAM recommendations into action.
Inter-Professional Consensus Curriculum on Diagnosis and Diagnostic Error
With support from the Josiah Macy Jr. Foundation, SIDM is working with an inter-professional group of experts to develop a consensus curriculum around diagnosis. After completing a systematic literature review, resulting in hundreds of relevant articles on medical education and diagnosis, or clinical reasoning and competencies, a Consensus Committee is in the process of identifying the competencies needed to improve diagnostic performance with the goal of ultimately endorsing them for adoption in education and training.
Patients Improving Research in Diagnosis
With funding from a Eugene Washington PCORI Engagement Award from the Patient-Centered Outcomes Research Institute (PCORI), Patients Improving Research in Diagnosis, will develop and evaluate an innovative curriculum to train Patient Partners to participate in the design, execution and dissemination of research to improve diagnosis. SIDM and its partners from Project Patient Care (PPC) and the MedStar Institute for Quality and Safety will also work together to develop a new Academy for Patient Partners.
Patient Partners will be recruited from organizations representing patients and other leading healthcare organizations. Each Patient Partner will be assigned to a Research Mentor who will facilitate their engagement in research activities, evaluate the effectiveness of the program, and plan for its sustainability. The program will work toward:
- Engaging a diverse set of disease-based and other healthcare organizations in diagnostic research
- Training Patient Partners to be ready to collaborate in diagnostic research
- Mentoring Patient Partners to provide an effective support network
- Promoting Patient Partners to active researchers in diagnosis
- Evaluating the project to inform future work
- Developing a plan to sustain the Patient Partner training initiative for diagnostic research through an Academy for Patient Partners
A multidisciplinary team of internists, hospitalists and radiologists are collaborating to reduce diagnostic delay of lung cancer through follow-up of incidental pulmonary nodule findings. We aim to develop a novel system to track and actively monitor incidental pulmonary nodules with a follow-up process that enhances patient communication, reduces in-basket burden for primary care providers and monitors follow-up imaging completion. This process, once developed and tested, may be expanded to other subcritical imaging findings. We are hoping to learn from our colleagues in the Coalition that have already begun spearheading similar work.
Washington Patient Safety Coalition, a program of the Foundation for Health Care Quality, chose diagnostic process as a key goal for 2018-2019. Through their Action Planning Subcommittee: Diagnostic Process, they are uniting around three tactics: raising awareness of the burning platform, developing a focus through collaboration and evidence-base, and promoting collaborative diagnosis (including patient/family). They are currently pursuing these through webinars, blog posts, and newsletters focused on diagnostic process, strategic partnerships with those active in this effort including membership with SIDM and collaborations with its staff and board, and a dedicated track at the 2019 Northwest Patient Safety Conference.
WomenHeart has created resources for dissemination that offer important insights, tips, and recommendations for any woman undergoing cardiac diagnostic testing. The organization aims to highlight women heart patients’ experiences—and the unique challenges they face—when communicating with healthcare providers about their diagnosis and help them to advocate for better policies and practices to address challenges with cardiac diagnostic testing.
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Every nine minutes, someone dies due to a wrong or delayed medical diagnosis.
Join Our Coalition
The Coalition to Improve Diagnosis, convened and led by the Society to Improve Diagnosis in Medicine (SIDM), is a collaboration of more than 50 leading healthcare organizations focused on ensuring that diagnoses are accurate, communicated and timely.