The survey results revealed several opportunities for specific interventions being developed and piloted in different units across the health system. To address survey findings, specifically perceptions that certain team members do not have adequate time, a pilot project "Diagnostic Team" is being implemented in the Transplant Unit to allow better functioning of the medical teams.4
The goal is to promote daily structured multidisciplinary rounds, conducted by the nurse leading the case, to address active problems of hospitalized patients. Such rounds include discussions of diagnostic and therapeutic goals, potentially high-stress situations such as clinical deterioration and code activation, and contingency plans and criteria for escalation of care. These rounds are performed on selected at-risk patients, including patients hospitalized for less than 24 hours who had diagnostic uncertainty, patients who were readmitted, and all seriously ill patients.
Improvement actions are being carried out to implement teamwork principles. Initial work was conducted in the Transplant Unit (critical and semi-intensive care) of this hospital using Plan-Do-Study-Act (PDSA) cycles to learn and then disseminate knowledge to other wards in the hospital. To increase awareness of diagnostic safety, TeamSTEPPS® for Diagnosis Improvement5 is being used to introduce the concept of a broad multidisciplinary diagnostic team that includes nonclinicians, patients, and their families. An additional goal is assessment and training to support local efforts to reduce diagnostic errors.
To improve communication gaps, we implemented changes in the Radiology Department to optimize interaction between the departments of public care services and radiology. A list of telephone extensions of available radiologists was published and disseminated to improve communication between the care teams of public hospitals and the radiology specialists they refer to. Furthermore, a QR code was created in the report itself to facilitate diagnostic interactions with the Radiology team. When the code is scanned, the team can report queries, make suggestions, and give feedback on the results of the report.
We are also leveraging opportunities to improve feedback related to diagnosis, building on prior work on this topic.6-8 For instance, we are implementing periodic meetings to disseminate lessons learned from diagnostic errors. In addition, we intend to introduce structured feedback methods, such as the ADAPT (Ask-Discuss-Ask-Plan Together) Framework,9 to strengthen learning from physicians' clinical practice.
We are also promoting the adoption of better information management principles and established best practices, such as evaluating differential diagnoses and defining therapeutic goals based on the diagnosis.10 We plan to build on existing practice management programs at our institution to monitor each professional’s performance in applying these best practices.
Our survey has proven invaluable in identifying areas for optimizing the diagnostic process within our healthcare system. Physician perspectives have highlighted the need for better communication and collaboration within healthcare teams, the importance of feedback in the diagnostic process, and the potential to enhance relationships with other diagnostic specialties, such as radiology. We plan to conduct future surveys to assess the impact of our program. Other healthcare systems can similarly use the diagnostic safety culture survey to better understand and improve their current practices related to the diagnostic process.
