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.
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.
Recent IHQSE graduate Shannon Acker, MD, was an author on an article published by JAMA advocating for better support systems for trainees during pregnancy and early parenthood. In addition to new policies from the Accreditation Council for Graduate Medical Education, Dr. Acker and her colleague emphasize the importance of a cultural shift and a comprehensive network of support for your parents.
IHQSE Alumna Diane Christopher, MD, was the lead author on a study investigating the current state of quality and patient safety (QPS) efforts in OB/GYN departments in the U.S. Dr. Christopher and her colleagues found that while departments leaders responded overwhelmingly positively regarding work to improve patient safety, most QPS committee leaders received neither protected time nor financial support, and formal training was required in less that one-third of the departments. The study also found that most departments monitored key performance indicators (KPI) for inpatient outcomes, but only half tracked outpatient KPI. Dr. Christopher and her colleagues concluded that OB/GYN departments should invest more resources in QPS efforts to fully realize the benefits to providers, patients, and hospitals.
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.
Peripherally inserted central catheters (PICCs) provide reliable central vascular access for hospitalized patients, but PICCs are associated with morbid and potentially lethal complications. To curb these outcomes, IHQSE Faculty Dr. Tyler Anstett and team developed a decision support tool in the EHR to help hospital-based providers utilize more appropriate catheter devices for their patients.
The transfusion of blood is a life-saving measure but is sometimes overused leading to worse outcomes for patients and excess costs for health systems. A team including IHQSE Faculty member Dr. Tyler Anstett engaged clinicians from different specialties to rethink the design of blood transfusion orders in the EHR at University of Colorado Hospital.
Andrea Prinzi, Ph.D., MPH, a member of the 2020 cohort of the IHQSE Certificate Training Program published their work in the Journal of Clinical Microbiology, showing that endotracheal aspirate cultures commonly overreport lower respiratory tract infections due to contamination, often resulting in excess antimicrobial therapy.