Increasing Physician Reporting of Diagnostic Learning Opportunities

Area of Science:

• Pediatric hospital medicine
• Quality improvement methodologies
• Patient safety research

Background:

• Diagnostic errors affect an estimated 10% of Americans annually, with limited data on pediatric diagnostic errors.
• Physician reporting is crucial for identifying diagnostic errors, but the pediatric hospital medicine (PHM) division had minimal reporting (1 report in 4 years).
• The study aimed to increase attending physician reporting of suspected diagnostic errors in the PHM service.

Purpose of the Study:

• To improve attending physician reporting of suspected diagnostic errors in pediatric hospital medicine.
• To increase reporting from 0 to 2 per 100 PHM patient admissions within 6 months.
• To foster a culture of psychological safety for reporting potential diagnostic errors.

Main Methods:

• Utilized the Model for Improvement framework within the PHM service.
• Rebranded "diagnostic error" as "diagnostic learning opportunity" (DLO) to promote a safe reporting culture.
• Implemented an electronic reporting form, reminders, reflection time, and progress reports; tracked DLOs per 100 admissions on an annotated control chart.

Main Results:

• Reporting increased from 0 to 1.6 DLOs per 100 patient admissions within 13 weeks, demonstrating sustained improvement.
• The increase met special cause variation, indicating a significant intervention effect.
• Formal review revealed that 66% of reported DLOs were true diagnostic errors, often multifactorial.

Conclusions:

• Quality improvement methods, emphasizing psychological safety, effectively increased physician reporting of DLOs.
• The generated data provides valuable insights for future improvements in pediatric diagnostic accuracy and patient safety.
• The study highlights the success of reframing error reporting to encourage participation and data collection.