Physical therapy (PT) in inpatient settings is a limited and valuable resource. Inappropriate PT consultation is costly and can lead to delays in care and discharge planning. A team of IHQSE alumni, including faculty members, Dr. Emily Gottenborg and Dr. Moksha Patel, dug into the root causes of unnecessary PT consultations and deployed an intervention that reduced the rate of inappropriate PT consults to less than 10%.

Diagnostic error is common, morbid, and mortal. IHQSE faculty member, Dr. Katie Raffel, along with Dr. Andrew Auerbach and other experts on diagnostic error, recently published findings from a multicenter retrospective cohort study in which 2500 hospitalized adults who experienced ICU escalation or death were evaluated for diagnostic error. This study adds to a body of literature highlighting the importance of diagnostic safety within hospital medicine.

The early COVID-19 pandemic created substantial disruption to healthcare delivery, including changes to diagnostic processes. In this 8-center retrospective cohort study of diagnostic error among patients hospitalized with possible COVID-19, IHQSE Faculty Member Dr. Katie Raffel found that 14% of the 257 patients included experienced delayed, missed or wrong diagnosis, 1/3 of which may have led to harm. Unexpectedly, diagnostic process faults related to policies/procedures related to COVID-19 suspicion itself (such as need for isolation or medical distancing) were not independently associated with error. Instead, diagnostic process faults related to clinical assessment and test ordering/interpretation remained most prominent, similar to other studies of the diagnostic process.

Faced with rising maternal mortality, the first prenatal visit is essential but, in many cases, important topics are missed. An IHQSE small grant supported the redesign of the first visit, dividing it into a nurse-led telemedicine visit and an in-person visit with an obstetric clinician. Clinic no-shows dropped (9.9%-4.2%), the topics covered in the first prenatal visit increased (70.0%-95.6%), and improvements were observed for all key themes.