SHM Converge Scientific Abstract ePoster Gallery-Patterns in the Noise: Understanding Adaptive Approaches to Accurate Diagnosis in Hospital Medicine Using a Rapid Qualitative Approach

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This study used a rapid qualitative approach to explore how hospitalists make accurate diagnoses amid everyday complexity. Conducted as part of a larger AHRQ-funded diagnostic excellence project, it recruited 31 hospitalists from academic centers across the U.S. for seven Zoom focus groups in 2024.<br /><br />The discussions asked three main questions: what habits and team practices help diagnosis go well, what common challenges interfere with diagnosis, and how systems and teams adapt to diagnostic complexity. Researchers analyzed the data using templated summaries and matrix analysis to identify major themes.<br /><br />Three broad themes emerged. First, the hospitalist role and care setting strongly shape diagnostic thinking. Frequent new admissions, time pressures, teaching responsibilities, and structural features of the job influence how clinicians reason through cases. Second, practical barriers such as interruptions, pages, texts, secure messages, competing priorities, divided attention, and electronic health record inefficiencies make diagnosis harder. Third, internal cognitive processes also matter. Hospitalists described diagnostic “momentum,” “inertia,” constant triage, the need for trust, and balancing independent thinking with conversation and feedback.<br /><br />The study also identified actionable system supports for safer diagnosis. These include salary-based payment structures that emphasize quality, better information technology and EHR interoperability, admission and handoff structures that support focused diagnostic work, workload limits such as staffing and census caps, and a culture that promotes camaraderie and feedback through case review and conferences.<br /><br />Overall, the findings show that complexity is inherent to hospital medicine. The authors argue that a Safety-II lens is useful because it focuses not only on preventing error but on creating conditions that help hospitalists adapt, collaborate, and think effectively. Supporting these conditions may foster diagnostic excellence in hospitals.

Asset Subtitle

Monisha Bhatia

Meta Tag

Author List Andrew D. Auerbach, Angela Keniston, Gopi J. Astik, James D. Harrison, Jeffrey L. Schnipper, Katie E. Raffel, Kristen Kipps, Marisha Burden, Monisha Bhatia, Sara Westergaard

Category Research

Concept Diagnostic Reasoning

Concept Diagnostic Excellence

Concept Hospitalist

Concept Diagnostic Complexity

Concept Safety II

Distinguished Non-Finalist

Presenter Organization Ucsf

Presenting Author Monisha Bhatia

Track Patient Safety

Keywords

hospitalist diagnosis

diagnostic excellence

qualitative study

hospital medicine

cognitive processes

electronic health record

team communication

diagnostic complexity

patient safety

system supports

Diagnostic Reasoning

Diagnostic Excellence

Hospitalist

Diagnostic Complexity

Safety II