SHM Converge Scientific Abstract ePoster Gallery-Assessing Organizational Readiness to Pursue Diagnostic Excellence Collaboration

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This study, part of the AHRQ-funded ADEPT initiative, examined how prepared 16 mostly academic U.S. medical centers are to improve diagnostic safety for adult inpatients. Diagnostic error is estimated to affect about 5% of adult hospitalizations and can lead to longer stays, higher costs, and worse outcomes.<br /><br />A 37-item survey of site leads was deployed in early 2023 to assess current organizational readiness, case identification and review practices, available resources, and barriers to progress. Overall, the sites showed wide variation in how they detect, measure, and track diagnostic error, and very few had active interventions in place.<br /><br />Common strengths included efforts to improve acceptance of errors, promote feedback, and share findings with clinicians and leadership to increase transparency. Some institutions were also highlighting effective practices to reinforce them. However, major barriers included the complexity and variety of diagnoses, limited financial support, and lack of institutional prioritization.<br /><br />Several sites had implemented related safety strategies, such as improving culture of feedback, diagnostic reasoning curricula, interprofessional communication training (for example, TEAM STEPPS), patient engagement efforts, and burnout support programs. While 87% reported mental or emotional support programs for clinicians, most required clinicians to seek them out. Likewise, 87% had patient and family advisory councils, but only 19% regularly interacted with Hospital Medicine PFACs.<br /><br />For case review, 50% used triggered chart review to identify diagnostic error, and 69% may have sent identified cases to root cause analysis, though the process varied. Only 43% integrated diagnostic error into existing safety and quality infrastructure. Although many sites had dashboards for mortality or escalation of care, none displayed diagnostic error rates.<br /><br />The study concludes that current readiness for diagnostic excellence is uneven, and future progress will require stronger leadership commitment, greater patient engagement, expanded interprofessional focus, and possibly machine learning tools to detect errors.

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Ellen Barbouche

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Author List Alisha Mehta, Andrew D. Auerbach, Anne S. Linker, Anuj K. Dalal, Aveena Kochar, Ellen Barbouche, Jeffrey L. Schnipper, Katie E. Raffel, Molly A. Kantor, Peter Barish, Sumant Ranji

Category Research

Concept Diagnostic Excellence

Concept Diagnostic Safety

Concept Diagnostic Error

Concept Leadership Commitment

Concept Leadership Support

Distinguished Non-Finalist

Presenter Organization University of Wisconsin School of Medicine and Public Health

Presenting Author Ellen Barbouche

Track Patient Safety

Keywords

diagnostic safety

diagnostic error

hospital readiness

adult inpatients

medical centers

AHRQ ADEPT

case review

patient engagement

leadership commitment

machine learning

Diagnostic Excellence

Diagnostic Safety

Diagnostic Error

Leadership Commitment

Leadership Support