Patient and family engagement is essential to effective and safe diagnosis. OurDX is a previsit online engagement tool to help identify opportunities to improve diagnostic safety in patients and families living with chronic conditions. In this study, researchers implemented OurDX in specialty and primary care clinics at two academic healthcare organizations and examined the potential safety issues and whether patient/family contributions were integrated into the post-visit notes. Qualitative analysis of 450 OurDX reports found that participants contributed important information about the diagnostic process. Participants with diagnostic concerns were more likely to raise concerns about the diagnostic process (e.g., access barriers, problems with tests/referrals, communication breakdowns), which may represent diagnostic blind spots.

A missed or delayed diagnosis of stroke places patients at risk of permanent disability or death. This article describes how interdisciplinary teams used a failure modes, effects, and criticality analysis (FMECA) to create an acute stroke diagnostic process map, identify failures, and highlight existing safeguards. The FMECA process identified several steps in the diagnostic process as the most critical failures to address, including failure to screen patients for stroke soon after presentation to the Emergency Department (ED), failure to obtain an accurate history, and failure to consider a stroke diagnosis during triage.

Patients and families are encouraged to play an active role in patient safety by, for example, reporting inaccurate or incomplete electronic health record notes after visits. In this study, patients and families at two US healthcare sites (pediatric subspecialty and adult primary care) were invited to complete a survey (OurDX) before their visit to identify their visit priority, recent medical history/symptoms, and potential diagnostic concerns. In total, 7.5% of patients and families reported a potential diagnostic concern, mainly not feeling heard by their provider.

… of AI that affect reliability. … Classen DC, Longhurst C, Thomas EJ. Bending the patient safety curve: how much can AI …

Patients who access their electronic health record (EHR) through a patient portal have identified clinically relevant errors such as allergies, medications, or diagnostic errors. This study focused on patient-identified diagnostic safety blind spots in ambulatory care clinical notes. The largest category of blind spots was diagnostic misalignment. Many patients indicated they reported the errors to the clinicians, suggesting shared notes may increase patient and family engagement in safety.

Striving for “zero harm” in healthcare has been advocated as a patient safety goal. In this article, the authors discuss the unintended consequences of “zero harm” goals and provide an alternative approach emphasizing learning and resilience goals (leveled-target goal setting, equal emphasis goals, data-driven learning, and developmental) rather than performance goals.

… J Healthc Qual … Medical errors in the neonatal intensive … including healthcare-acquired infection. … Nether KG,  Thomas EJ, Khan A, et al. Implementing a robust process … in the neonatal intensive care unit to reduce harm. J Healthc Qual. 2022;44(1):23-30. …

… J Perinatol … Patients in the neonatal intensive care unit … seven days of admission was 6.2%. … Shafer GJ, Singh H, Thomas EJ, et al. Frequency of diagnostic errors in the … intensive care unit: a retrospective cohort study. J Perinatol. Epub 2022 Mar 4. doi: 10.1038/s41372-022-01359-9. …

… emotional, physical, and financial harm . … Bell SK,  Dong J, Ngo L, et al. Diagnostic error experiences of patients and …

Diagnostic safety interventions have been empirically evaluated but real-world implementation challenges persist. This commentary discusses the importance of incorporating contextual factors (e.g., social, cultural) facing complex healthcare systems into the design of diagnostic safety interventions. The authors provide recommendations for designing studies to improve diagnosis that take contextual factors into consideration.

This qualitative study explored the long-term impacts experienced by patients and family members involved in medical harm events. Participants described psychological, social/behavioral, and financial impacts and more than half reported ongoing physical impacts.

Effective communication between patients and providers – including after an adverse event – is essential for patient safety. This qualitative study identified unique challenges experienced by parents and providers when communicating about adverse birth outcomes – high expectations, powerful emotions, rapid change and progression, family involvement, multiple patients and providers involved, and litigious environment. The authors outline strategies recommended by parents and providers to address these challenges.

Engaging patients and families in their own care can improve outcomes, safety, and satisfaction. This study brought patients, families, clinicians and experts together to identify patient-reported diagnostic process-related breakdowns. The group identified 7 categories, 40 subcategories, 19 contributing factors and 11 patient-reported impacts. Breakdowns were identified in each step of the diagnostic process.

… and drivers of safety culture. … Bisbey TM, Kilcullen MP, Thomas EJ, et al. Safety culture: an integration of existing …

… threats. Acad Pediatr. Epub 2020 Jul 17. doi: 10.1016/j.acap.2020.07.014 …

… in patient outcomes. … Stulberg JJ, Huang R, Kreutzer L, et al. Association between surgeon technical skills and …

… J Patient Saf Risk Manag … This editorial discusses priority … of health care workers during the COVID-19 pandemic. J Patient Saf Risk Manag. 2020;25(3):93–96. doi: …

… can affect team performance.  … Tannenbaum SI, Traylor AM, Thomas EJ, et al. Managing teamwork in the face of pandemic: …

Achieving “zero harm” has been advocated as a patient safety goal. This editorial proposes that the conversation shift from striving to achieve absolute safety (Zero Harm) towards actively managing risk using both reactive and proactive approaches to safety management.

… involved in the error. … Prentice JC, Bell SK, Thomas EJ, et al. Association of open communication and the …