1. Strategies to Test for Diagnostic Error and Ambulatory Patient Safety
Paula Griswold
Executive Director

2. Coverys - Diagnostic Accuracy: Room for Improvement
Diagnosis-related failures are the single largest root cause of claims
54 % of diagnosis-related claims resulted in “high-severity injury”
36% percent result in patient death
Mostly from non-hospital settings:
Office/clinic - 35 percent
Emergency Department/Urgent Care - 24 percent
Lab/Testing - 18 percent
Provider- type:
General Medicine percent
Hospital/Facility – 19 percent
Radiology - 14 percent
Medical subspecialties percent
Emergency Medicine - 11 percent-
Top conditions
Cancer - 27 percent
Infections - 13 percent
Cardiac/Vascular - 8 percent
Fractures/Dislocations – 5 percent
Myocardial Infarction – 4 percent
% of claims
Closed claims
Hanscom, R., Small, M. & Lambrecht, A. (March 2018)
Diagnostic Accuracy: Room for Improvement. Coverys.

3. Coverys - Diagnostic Accuracy: Room for Improvement
Drivers of these claims:
“Clinical Judgment” of healthcare providers is largest category percent
Narrow diagnostic focus percent
Inadequate or inappropriate testing percent
Misinterpretation of diagnostic studies percent
Failure to adequately assess the patient’s condition percent
“ Clinical Systems” involved in 16 percent of cases
Failure to manage the patient’s follow-up care - 17 percent
Insufficient studies ( e.g. imaging)– 16 percent
Results or specimens lost/misfiled, or MD unaware of results percent
Lack of coordination of care – 10 percent
Failure to inform patients of test results – 8 percent
Hanscom, R., Small, M. & Lambrecht, A. (March 2018)
Diagnostic Accuracy: Room for Improvement. Coverys.

4. Diagnosis Error in Office Practice Setting: Strategies to Test in QI Process
For office practices – Coalition faculty offered strategies to test during patient visits – “small tests of change”
QI Method within practice:
Perform small tests of change during appropriate office visits
Debrief with patient/clinicians/staff to discuss impact
Continue to test and adapt approach based on experience

5. QI for Diagnostic Error: Three Strategies to Test
Testing strategies to address cognitive bias/improve communication
Stalling premature closure: “What else could it be?”
Mitigating confirmation bias: “What data doesn’t fit?”
Partnering with patient to improve communication – test hypothesis:
Explain – “This is most likely diagnosis, but I need information from you after this visit”
Describe the expected outcome of the treatment
Ask the patient to call with result – ( EITHER WAY? Or if it didn’t work)
Plan follow-up call
LEARNED THIS: Need standard language for the patient and the front desk staff
?? “ The doctor asked me to call to say the treatment didn’t work as predicted”
Evaluate as clinician, with staff, and with patient

6. Ambulatory Patient Safety: Patient Safety Programs in All Settings
8 page guideline
Collaborative effort
Designed for setting with few resources

7. Ambulatory Patient Safety: Patient Safety Programs in All Settings
Systems & Culture
Elements of a Safe Practice
Leadership for safety
Point person for safety
Process improvement made simple
When something goes wrong
Learn from patients and families