R18HS029346

Re-engineering patient and family communication to improve diagnostic safety resilience - Abstract

The diagnostic process unfolds across multiple settings over time. Risk factors for error in each setting may vary, but for the patient, once a serious diagnostic error occurs, the specific clinical area where it happened is unimportant.

Outpatient and inpatient settings have similar rates of diagnostic harm. Interactions within and between clinical teams and settings may either create resilience or increase risks for failure.

Resilience engineering, or Safety II, is based on the concept that safety is a consequence of adaptations to the changing conditions of a system's function. Robust communication supports a shared mental model that may create diagnostic resilience.

Currently, clinician-patient/family communication along the diagnostic journey is haphazard. For example, pediatricians consistently fail to tell parents about "red flags" which are signs of a serious complication requiring immediate attention. Among children with chronic conditions at home, we found that 14% had serious diagnostic delays caused by parental misunderstanding of instructions.

Pediatric diagnostic safety is understudied, and overall rates and types of outpatient pediatric diagnostic errors are unknown.

To support robust communication with families of hospitalized children, we developed a structured communication intervention (PFC I-PASS) which reduces medical errors by 38%. I-PASS has been pilot tested for use during hospital discharge with similar success. Secondary analyses suggest that I-PASS may be effective at reducing diagnostic errors. PFC I-PASS has not been used in the outpatient setting and its impact on diagnostic safety has not been tested.

Among children with multiple chronic conditions, we aim to:
1. Characterize the diagnostic journey, focusing on successes, errors, and patient/family and clinician communication;
2. Adapt PFC I-PASS to create outpatient PFC I-PASS, a structured communication intervention for patients/families and clinicians in the outpatient setting;
3. Evaluate the effectiveness of PFC I-PASS (outpatient and discharge) to improve patients/family and clinician communication and experience, and to reduce errors and harm.

The proposed Diagnostic Center of Excellence is comprised of two cores: a Methods Core and an Education and Dissemination Core. Cores include expertise in diagnostic safety, Safety I and II, communication, medical education, and health disparities. The cores will work with patient and parent, clinician, and health system leader advisory panels.

At Boston Children's Hospital, Cincinnati Children's Hospital Medical Center, and Children's Hospital of Philadelphia, to address aims, we will employ observations, interviews, simulation, surveys, chart review, using S1 and S2 approaches. We will evaluate the impact of adapted PFC-I PASS on diagnostic errors using interrupted time series analysis.

Methods will be immediately available to other centers of diagnostic excellence and, through several networks, to over 200 health systems. Combining S1 and S2 approaches to characterize the diagnostic journey and test interventions has the potential to transform patient safety science.

Children's Hospital Corporation

TO SUPPORT RESEARCH AND EVALUATIONS, DEMONSTRATION PROJECTS, RESEARCH NETWORKS, AND MULTIDISCIPLINARY CENTERS AND TO DISSEMINATE INFORMATION ON HEALTH CARE AND ON SYSTEMS FOR THE DELIVERY OF SUCH CARE INVOLVING: (1) THE QUALITY, EFFECTIVENESS, EFFICIENCY, APPROPRIATENESS AND VALUE OF HEALTH CARE SERVICES, (2) QUALITY MEASUREMENT AND IMPROVEMENT, (3) THE OUTCOMES, COST, COST-EFFECTIVENESS, AND USE OF HEALTH CARE SERVICES AND ACCESS TO SUCH SERVICES, (4) CLINICAL PRACTICE, INCLUDING PRIMARY CARE AND PRACTICE-ORIENTED RESEARCH, (5) HEALTH CARE TECHNOLOGIES, FACILITIES AND EQUIPMENT, (6) HEALTH CARE COSTS, PRODUCTIVITY, ORGANIZATION, AND MARKET FORCES, (7) HEALTH PROMOTION AND DISEASE PREVENTION, INCLUDING CLINICAL PREVENTIVE SERVICES, (8) HEALTH STATISTICS, SURVEYS, DATABASE DEVELOPMENT, AND EPIDEMIOLOGY, (9) DIGITAL HEALTHCARE RESEARCH, AND (10) PATIENT SAFETY RESEARCH, INCLUDING HEALTHCARE-ASSOCIATED INFECTIONS. IN SUPPORT OF THIS RESEARCH, THE AGENCY HAS A SPECIAL INTEREST IN HEALTH CARE AND ITS DELIVERY IN THE INNER CITY, IN RURAL AREAS, AND FOR PRIORITY POPULATIONS (LOW-INCOME GROUPS, MINORITY GROUPS, WOMEN, CHILDREN, THE ELDERLY, AND INDIVIDUALS WITH SPECIAL HEALTH CARE NEEDS).

93.226 - Research on Healthcare Costs, Quality and Outcomes

Division of Grants Management [HHS - AHRQ]

Center for Quality Improvement and Patient Safety (CQuIPS) [HHS - AHRQ]

Boston, Massachusetts 021155724 United States

Single Zip Code

Diagnostic Centers of Excellence: Partnerships to Improve Diagnostic Safety and Quality (R18) (RFA-HS-22-008)

Amendment Since initial award the total obligations have increased 300% from $998,261 to $3,990,551.