Stop Dropping the Ball: Improving Diagnosis Across Transitions of Care in Rural Communities

1. Stop Dropping the Ball: Improving Diagnosis Across Transitions of Care in Rural Communities

2. Background and Significance Diagnostic error is one of the most important safety problems in health care today • There is a clear need for process improvement and meaningful patient engagement surrounding diagnostic test management. • This process begins with ordering a test and ends with communicating the result and necessary next steps to the patient. • Diagnostic test management is critical to accurate and timely diagnosis, but effective follow-up systems are flawed and often riddled with work-arounds, particularly across transitions of care.

3. Background and Significance Research Question: What is the effectiveness of community-engaged strategies to improve appropriate diagnostic test follow-up after discharge from a rural emergency department? This project aims to decrease diagnostic error risk by: • Partnering with community members and providers to redesign the test reporting workflow, and • Implementing improvement ideas that have the highest potential to prevent follow-up system failures (FUSFs), and thereby, diagnostic errors. 

4. Project Partners & Funding • Minnesota Alliance for Patient Safety (MAPS) • Overall project management • Patient engagement expertise and focus • Lakewood Health System • Emergency Department, project management, physician champion leadership • PFAC, Medical Home Advisory Board, other community groups, and individual patient interviews • University of Minnesota, Department of Medicine • Medical researcher - Dr. Andrew Olson • RPAP students • Stratis Health • Process mapping expertise, Reid Haase • Building Healthier Communities grant funding for patient engagement portion of project • MMIC/Constellation • Overall project funding • Data and expertise in diagnostic errors

5. This research project is centered on co-designing a new process with community members and patients to minimize the possibility of test result follow-up system failures (FUSFs). The patient and family perspective is critical in creating a new process that is reliable, safe, and efficient. The project will run through 2020.

6. Project Stages • Goals: • Develop and validate a practical measurement strategy • Understand patients’ current experiences • Identify ED workflow process failures and best practices • Projected Timing: • June-December 2019 • Develop measurement strategy for appropriate test result follow-up upon ED discharge • Below are specific tests and 12-month period averages for Lakewood Health System ED • Blood Cultures: 59 ordered/month • Urine cultures: 60/month • Creatinine: 270/mo(include only BMP, CMP and renal panels) • Chest CT: 12.25/mo • Chest x-ray: 86/mo • Gather pre-intervention data and analyze • Map current state workflows that depict current diagnostic test result follow-up

7. Project Stages Goal: Re-design the process through a community engaged approach Projected Timing: Sept/Oct-Dec 2019

8. Project Stages • Goal: • Implement newly co-designed process and use the measure designed from Stage 1 to determine its effect on the rate of appropriate follow-up • Decrease FUSFs by 10% • Projected Timing: • January-December 2020

9. Next Steps • Initial meeting with PFAC July 18 • Data collection is underway • Planning for additional site visits is underway • Current and future state mapping to be scheduled for September or October