Advancing Diagnostic Safety Research: Results of a Systematic Research Priority Setting Exercise

Abstract

Background Diagnostic errors are a major source of preventable harm but the science of reducing them remains underdeveloped. Objective To identify and prioritize research questions to advance the field of diagnostic safety in the next 5 years. Participants Ninety-seven researchers and 42 stakeholders were involved in the identification of the research priorities. Design We used systematic prioritization methods based on the Child Health and Nutrition Research Initiative (CHNRI) methodology. We first invited a large international group of expert researchers in various disciplines to submit research questions while considering five prioritization criteria: (1) usefulness, (2) answerability, (3) effectiveness, (4) potential for translation, and (5) maximal potential for effect on diagnostic safety. After consolidation, these questions were prioritized at an in-person expert meeting in April 2019. Top-ranked questions were subsequently reprioritized through scoring on the five prioritization criteria using an online questionnaire. We also invited non-research stakeholders to assign weights to the five criteria and then used these weights to adjust the final prioritization score for each question. Key Results Of the 207 invited researchers, 97 researchers responded and 78 submitted 333 research questions which were then consolidated. Expert meeting participants (n = 21) discussed questions in different breakout sessions and prioritized 50, which were subsequently reduced to the top 20 using the online questionnaire. The top 20 questions addressed mostly system factors (e.g., implementation and evaluation of information technologies), teamwork factors (e.g., role of nurses and other health professionals in the diagnostic process), and strategies to engage patients in the diagnostic process. Conclusions Top research priorities for advancing diagnostic safety in the short-term include strengthening systems and teams and engaging patients to support diagnosis. High-priority areas identified using these systematic methods can inform an actionable research agenda for reducing preventable diagnostic harm.

Role of primary care physician factors on diagnostic testing and referral decisions for symptoms of possible cancer: a systematic review

“…Though years of experience is not modifiable, clinical experience may be more important and mutable through simulated diagnostic experiences that increase exposure to presentations that could be due to cancer. 76 …”

“…Thus, the ability of PCPs to access and leverage 'gut feeling' in interventions for enhancing empathy75 may be more instinctive to some PCPs than others. Though years of experience is not modifiable, clinical experience may be more important and mutable through simulated diagnostic experiences that increase exposure to presentations that could be due to cancer 76…”

Diagnostic error experiences of patients and families with limited English-language health literacy or disadvantaged socioeconomic position in a cross-sectional US population-based survey

“…Did you understand the explanation for your symptoms (the diagnosis) and the next steps? may prove critical in efforts to engage patients in diagnosis 61 62. Clinicians should more actively involve patients and families with LEHL or dSEP in decision-making to arrive at next steps together, adapting shared decision-making to the diagnostic process, and ensure that patients and families understand next steps in the diagnostic process 63 64…”

Patient Identification of Diagnostic Safety Blindspots and Participation in “Good Catches” Through Shared Visit Notes

“…1,31 In addition, organizational reporting and characterization of diagnostic errors often lack the patient and family perspective, and may therefore miss important events. 16,[32][33][34] Drawing on the concept of blindspots, we suggest that patients and families can support the delivery of safe diagnoses through identifying diagnostic process-related safety breakdowns (e.g., gaps in patient histories, miscommunications, missing diagnostic tests and referrals,) that may not be captured by traditional safety data, such as clinician adverse event reporting, surveys, or electronic health record (EHR) triggers. [35][36][37] Where these blindspots emerge, the likelihood of error is increased, due to the clinician missing critical information about a patient's history or timely completion of the diagnostic evaluation.…”