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.

Few hospitals have created surveillance programs for diagnostic errors. Fewer have programs to translate those opportunities into improvement efforts to prevent future harm. IHQSE faculty Drs. Katie Raffel and Jeff Glasheen are part of the ADEPT working group funded through an AHRQ grant to build such a program. In this paper the authors share the methodology for building the surveillance program, creating the benchmarking dashboards, understanding the areas of opportunity, and building interventions. The program is live in 16 US hospitals.

A recent study by IHQSE alumna Jessica Kenny, PhD found that 7% of adolescents endorsed suicidal ideation (SI) in the most recent two weeks during a primary care visit. Multiple interventions were associated with reductions in SI frequency at a follow-up visit, including PCP referral to integrated behavioral health and family navigators, behavioral health providers conducting a risk assessment, completing a safety plan, involving caregivers, sending the adolescent to the emergency department when indicated, and referring to family navigators. The findings from this study support screening for SI and highlight specific multidisciplinary and family-centered interventions and recommendations to address adolescent endorsement of SI in pediatric primary care settings.