2024's @WHO World #PatientSafety Day focuses on #ImprovingDiagnosis. Here are 10 ideas to improve diagnostic safety at a #healthsystem + learn from (misdiagnosis/delayed dx) based on #experiments we did at the #SaferDX Learning Lab 2017-2022 at @GeisingerHealth #WPSD2024 #WPSD24

At #DEX26 significant announcement by @LeapfrogGroup - the optional section on diagnostic safety in their hospital survey will be now required and more importantly publicly reported from July 2027. This year 2500+ hospitals responded to the updated questions. This is an important nudge to health systems to focus on an issue that has been chronically ignored, buried in peer review committees (if at all recognized). True, that some health systems may stretch their answers, use it to check boxes, but it still remains one of the first structural/process options for hospitals to measure and address missed, delayed and mis-diagnosis. Not a magic pill, nor is it a perfect solution - and like CMS' PSSM (as it stands now) may not be audited or validated easily even if self-attested and publicly reported (leaving scope for reliability issues). Yet these are important first steps for health systems/ hospitals to step into a zone they have and would still avoid for a number of reasons. As far as I know it is the best excuse for diligent/interested clinicians or CQOs and CMOs to use this as a system-lever to kickstart work to improve #patientsafety with re to diagnostic errors (i.e. assign ppl, $ and resources and offer political willpower internally within orgs). This work has been going on for 5 years now - glad to have been part of Leapfrog's 12 member national advisory board that offered recommendations for best practices that influenced these Qs. Surveys can always do better but need to start somewhere- and in a field where there was literally nothing, this is very good. These are the latest Qs (version 3.0) - far more relaxed/simplified to give a viable/easy start to several hospitals (and potentially link to potential CMS and Joint Commission efforts) (for all best practices and case studies, see full report on recognizing diagnostic excellence- 2022, 2024) @pfps_us @LeapfrogGroup

Looking forward to #DEX26. Particularly interested for opening "fireside chat" with @Bob_Wachter. If I was interviewing him, my first question would be "why dont diagnostic errors get any respect and what can be done about it?" :) he wrote an imp paper in @Health_Affairs in 2010 with the exact same title. I think the concern holds true even today - we made progress in 2 decades-- upwards of $150 million were funneled by AHRQ (federal govt) and the Moore Fdn in the last 2 decades on finding out ways to reduce dx errors...but then the $ ended + also moved the conversation/lens to diagnostic excellence ( vs safety and errors) probably too soon. He was part of a national roundtable of experts i organized at this same meeting in 2013 in Chicago- everyone had high hopes from the great IOM report that came out 2 yrs later in 2015. Strong report but weak adoption except philanthropic org Moore remarkably funneling upwards of $100M and then closing out support. Infact back then the conference was called "diagnostic errors in medicine"- now its called DEX- "excellence" replacing "errors in medicine". My personal view is dx excellence is inherent to medicine- medicine (actual practice of medicine not the health care ecosystem) was always about dx excellence so we sort of lost focus/momentum from the sub-topic of timely/accurate dx to specifically reduce delays and misses. Dx excellence is, philosophically, to me akin to "pursuit of happiness" in the declaration of independence. Dx errors in 20 yrs met the same fate of pt safety in 40yrs. We are at a better place than 4 decades ago, but are we really, as in did we keep pace, have we become more transparent? Unless we know how to acknowledge and address our misses, it will always be a pursuit of excellence. Will be exciting nevertheless to hear him- he's written a very well researched and approachable book on AI and has been on a book tour (many on youtube). Chapters 3 and 4 relevant for today. Following his session, CMS, leapfrog and the joint commission take stage. Q for them is how to leverage what we know from $150million worth of 100s of papers so we can operationalize dx safety on the ground in hospitals? Leapfrog has a good survey but optional, CMS has PSSM measures but unaudited. I've tried to operationalize dx safety for abt a decade, and I can tell you, it actually does come down to the intersection of culture and what the law dictates. This can be heavily influenced by regulation (which influences the c suites to assign dollars, FTEs and resources). Like any other industry, market forces and regulations dictate health care. Market forces never focus much on safety as its too complex; ROIs dont get defined well. Leaving it to the intrinsic motivation of the good doctors and nurses creates variation. Regulations to address lack of transparency hold key to moving this conversation to a learning health system in the interest of patients, docs and the companies that manage health care. #patientsafety #medicalerrors #misdiagnosis #AI #diagnosticerrors #patientharm

Here's a random example of what "emergency presentation" of #cancer looks like. And why it would make sense to look back, learn, and correct course for the next patient. Don't get caught up in calling it an "error", but definitely a miss, to learn from birminghammail.co.uk/news/mi…

There is a weird type of distress when your worry moves beyond the emptiness in your chest and sort of twists your intestines or abdomen. I felt it when sandyhook happened. This AM its abt those kids in TX. Unbearable to imagine what's happening to those families right now.

#CMSQualCon25 Re-upping - at the federal session, @CDCgov Dr Arjun Srinivasan just brought up diagnostic excellence/ diagnostic safety toolkits- here is a thread on the core elements he referenced + more resources.

"This is an administration that's serious about #patientsafety - open to early conversations about disincentivizing i.e. adjusting payment in case of safety/harm events" Dr Michelle Schreiber DD/CMO of CMS. "Stop paying for preventable harm". Well, need to know about them first?