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.
Diagnostic errors (DE) are a critical but understudied cause of preventable patient harm. While much work has focused on examining the incidence and factors contributing to DEs in ambulatory and emergency room settings, fewer studies have examined the incidence of DEs in hospitals or how they contribute to adverse events during the hospital encounter. IHQSE Faculty, Dr. Katie Raffel, along with other experts on diagnostic error, led an AHRQ-funded study at 31 US hospitals aimed at defining the prevalence and underlying causes of DEs in patients who die in the hospital or are transferred to the ICU after the first 48 hours.
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.
Venipunctures are clinically necessary for hospitalized patients, but failed add-on lab tests can lead to excess venipunctures and patient harm. In a recent publication in Applied Clinical Informatics, IHQSE faculty member, Tyler Anstett, DO and team used QI methodology to identify a root cause of add-on failures and then implemented a simple and effective solution.
IHQSE Certificate Training Program Graduates Dr. Norman Friedman, Renee Crowder and Sarah Derieg developed a set of screening criteria to predict children who would need overnight monitoring after surgery for sleep-disordered breathing. They report that 75% of patients did not have a prolonged oxygen requirement making them candidates for same day surgery. The probability of a prolonged oxygen requirement was only 18% if patients did not have a diagnosis of asthma or a resting pulse oxygen measurement of < 96%. They conclude that all patients who are off oxygen within 3 hours of surgery and pass a sleep room air challenge are safe for discharge to home.
IHQSE Faculty member, Dr. Sarah Tevis, and team surveyed patients with stage 0-IV breast cancer about the information they received about potential sexual side effects of their treatment. The survey revealed that patients—most of whom receive little to no information—desire personalized education early and often to better navigate these effects during treatment.
Diagnostic errors are common and important causes of preventable morbidity and mortality in a variety of medical settings. Diagnostic errors leading to harm are most likely to involve diagnoses of cancer, vascular events, or infection. IHQSE Faculty, Dr. Katie Raffel, along with Sumant Ranji, MD, takes a look at approaches to measurement, etiologies, and interventions to decrease diagnostic error.
IHQSE faculty members, Drs. Emily Gottenborg, Jeff Glasheen, and Tyler Anstett, along with IHQSE alumna Dr. Julia Limes, published the first program evaluation of a residency training program focused on Hospital Medicine. The paper describes the University of Colorado’s experience of training over a hundred hospitalist residents over 15 years. Notably, the program found that graduates were highly likely to choose careers in hospital medicine with over 80% holding quality, safety and operational leadership roles.