Digital Health Safety Surveillance: Improving Patient Support Throughout the Diagnostic Trajectory

Missed and delayed diagnoses are a challenging critical patient safety concern and disproportionately affect minority populations. There is an urgent need for comprehensive approaches to diagnostic safety improvement.

In response to a sentinel event in 2013, Parkland Health established a centralized digital Safety Net Surveillance (SNS) program. The program initial focused on tracking delayed follow-up imaging resulting from incidental radiology findings and has now expanded to manage six high-risk diagnostic scenarios. By 2022 the SNS program was incorporated into the newly launched Digital Health Center, supported by a specialized team with bilingual capabilities using motivational interviewing health-related social needs screening, social worker integration, and electronic health record-integrated workflows to effectively identify and guide patients through follow-up care.

The number of cases supported by SNS staff for radiology findings increased from 223 (2018) to 819 (2022), with completion of follow-up scans improving from 41.3% at baseline to 96.6% after program implementation. Among those benefiting from intensified support and imaging follow-up, 3.1% required surgical intervention and 4.3% were diagnosed with cancer. The program demonstrated consistent improvement as it was expanded to additional high-risk triggers, including abnormal tumor markers (85.3% to 88.8%; p = 0.001) and new cancer follow-up (48.4% to 74.7%; p < 0.001). The program addressed diagnostic error inequities and implemented corrective measures for patients with missed diagnoses-49.7% Spanish-speaking, 65.9% women, and more than 40% from disadvantaged communities.

Parkland Health's SNS program significantly improved identification and management of missed and delayed follow-up to diagnostic tests. The program's innovative and replicable approach to comprehensive patient support offers a blueprint for other healthcare organizations to systematically address diagnostic errors and care disparities.