The greatest challenge will be getting everyone onboard and communicating that we don’t have to eat the whole elephant—we just need to get everyone focused on taking a little bite and make a change that will get patients engaged. This is a big problem representing a lot of studies.”
In a historic first for the coalition, Strategic Radiology was awarded a $282,000 grant from the Coverys Community Healthcare Foundation (CCHF) to research methods to ensure that patients are aware of incidental findings identified in imaging exams acquired in the ED, a setting fraught with communication challenges.
Improving the diagnostic process was identified as a moral, professional, and public health imperative by the Institute of Medicine in its September 2015 installment of the IOM’s Quality Chasm Series, Improving Diagnosis in Health Care. The authors—a coalition of experts including radiologist Hedvig Hricak, MD—synthesized what is known about diagnostic error and proposed ways to improve it.
Inspired by that report—as well as insights from the Coverys medical professional liability claims database—the CCHF committed $3 million for research that would address the improvement of diagnostic accuracy and issued a research request for proposals (RFP). Strategic Radiology was one of 11 awardees, including The Human Diagnosis Project, Johns Hopkins University School of Medicine, Wake Forest Baptist Medical Center, and the Mallinckrodt Institute of Radiology Interventional Radiology Section.
“The traditional method of transmitting results to the referring physician is not optimal for incidental radiological findings in the emergency department (ED) setting because the care takes place outside of established patient–physician relationships,” says Arl Van Moore Jr, MD, FACR, CEO and chair, Strategic Radiology. “We intend to prevent these findings from falling through the cracks by investigating solutions to deliver results directly to patients who undergo medical imaging in the ED.”
In exploring new ways to ensure that these findings are not lost, Strategic Radiology practices will investigate various direct-to-patient communication methodologies to put the findings in the hands of patients. In other words, the communication target will be the patients themselves and the messaging will need to be designed accordingly.
Ramping Up for Change
Lisa Mead, RN, CPHQ, CHPC, executive director of Strategic Radiology’s Patient Safety Organization, is currently assembling Strategic Radiology member practices that are willing and able to participate. Together, they will review the present state of incidental findings in the ED communication process beginning with the report structure, communication mechanisms, job titles of communication actors, and the involvement of the patient in the process.
Using the Plan-Do-Check-Act system of continuous quality improvement, participants will gather data, focusing initially on patients with lung nodules, outline current processes and actors, and plan a change with input from various stakeholders. A change will be tested on a small scale, results will be assessed, additional changes will be tested, and a best practice will be standardized, developed, and implemented on a larger scale. The ultimate goal is to develop an economically feasible system that can be replicated across the country to fill the current care gap.
Mead says the greatest obstacle in mounting a quality improvement activity for a significant health care challenge that involves multiple stakeholders is overcoming the naysayers.
“The greatest challenge will be getting everyone onboard and communicating that we don’t have to eat the whole elephant—we just need to get everyone focused on taking a little bite and make a change that will get patients engaged,” she says. “This is a big problem representing a lot of studies.”
Coverys, a provider of medical professional liability (MPL) insurance, reports that failure to diagnose —including missed diagnoses, wrong diagnoses, and delayed diagnoses—is the leading category of MPL, representing 32% of all Coverys claims between 2012 and 2016 and 44% of indemnity dollars.
Hill Medical in Pasadena, California, has committed to the project, and two other practices have expressed interest and are exploring the project with their hospital partners. Requirements of the participating practices include:
· Telephonic interview
· A site visit from Mead and introduction to hospital and ED
· Process mapping to assess current processes
· Brainstorming new ideas for implementing a process that would fill the gap to notify patients
“We want to create a deliverable that is easy and inexpensive to replicate and that we can at least begin to solve the issue of getting the patient engaged and having people be more aware of the findings so that we can decrease the harm,” Mead says. “Many patients come back four years later with disease that could have been diagnosed earlier with the proper follow-through.”
Hub is the monthly newsletter published for the membership of Strategic Radiology practices. It includes coalition and practice news as well as news and commentary of interest to radiology professionals.
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