- [Presenter] Welcome to the webinar
on the Toolkit for Engaging Patients
To Improve Diagnostic Safety.
In 2019, the Agency for Healthcare Research and Quality
sponsored the development of a toolkit
to improve diagnostic safety
by engaging patients and family members.
The Toolkit contains two strategies:
Be The Expert On You
and 60 Seconds To Improve Diagnostic Safety.
This webinar provides an overview of the Toolkit
and the strategies.
The objectives of this webinar
are to review the threats of diagnostic error
to patient safety,
describe the Toolkit
and how it can improve diagnostic safety,
provide strategies for implementing the Toolkit
in practice settings.
First, a little background.
The MedStar Health Institute for Quality and Safety
led development of the Toolkit
under a contract funded by the Agency
for Healthcare Research and Quality,
referred to as AHRQ.
The goal of the project was to develop,
implement, pilot test,
and promote a resource to engage patients and families
in the diagnostic process
to reduce diagnostic errors.
It's important to note
that the Toolkit was co-developed by patients,
providers, researchers, and contract officers at AHRQ,
so it brings to bear the worlds of practice and research,
along with patient experience.
Development partners also included
the Baylor College of Medicine,
Clinical Directors Network,
and the National Nurse-Led Care Consortium.
Diagnostic error is the leading patient safety challenge
in the United States
and is defined as the failure to
A, establish an accurate and timely explanation
of the patient's health problems,
or B, communicate that explanation to the patient.
Nearly every patient will experience a diagnostic error
in their lifetime
and 57% of all diagnostic failures
happen in ambulatory care,
In primary care settings,
79% of the errors in diagnosis
happen within the patient-clinician encounter
and up to 56%
of these are related to miscommunication
during the patient-clinician encounter.
Thus, resources to improve communication
within the patient provider encounter
are needed to improve diagnostic accuracy.
At the start of the project
an environmental scan was conducted
that identified several things patients and providers can do
to improve diagnostic safety.
For patients, one of the key strategies,
recommended by both patients and providers,
is for patients to tell their illness story, or history,
fully and completely.
Providers often report
that patients withhold information initially
that could have helped them make a diagnosis faster
or may have resulted in a different diagnosis.
Some patients report that they do not feel heard
by their providers,
which can lead to a breakdown of information sharing
during the clinical encounter.
So it's important for patients to tell their full story
and feel comfortable doing so.
Other strategies that have been recommended for patients
to help them partner in diagnosis
include conveying their symptoms, concerns, and history
in a clear and concise way,
asking questions when they don't understand,
and using checklists or other structured communication tools
to help them remember the information they want to convey
or ask about.
In addition, there are things providers can do
to help improve diagnosis,
specifically related to engaging patients
and their families.
For example, deep and reflective listening
is central to clear communication within the encounter.
Setting a visit agenda in collaboration with the patient
has been shown to improve communication,
particularly when that agenda
allows patients to share what's most concerning to them.
And being prepared for the patient visit
by checking any pre-labs
and reviewing the patient's clinical history
before the encounter can also enhance diagnostic accuracy,
especially when coupled with reflective listening.
Based on environmental scan findings,
our approach to the Toolkit
focused on paired tools,
meaning, if we gave an intervention focused on patients,
we also provided clinicians and practice staff
complementary tools to support the families and patient.
With the Be The Expert On You strategy,
patients are provided with a note sheet
to help them tell their story in a clear, concise way.
The note sheet can also serve as a prompt for patients
so they don't forget important information.
Coupled with this note sheet,
the 60 Seconds To Improve Diagnostic Safety strategy
aims to support providers
in engaging in deep and reflective listening
and fostering an environment for patients
to share their story.
By using the first minute of the encounter
as the "patients minute," providers can allow patients
to share their story,
their illness "history," uninterrupted.
Together, these strategies support a collaborative dialogue
and an accurate diagnosis.
Let's first look at the Toolkit's patient-facing strategy.
The Be The Expert On You note sheet
is an agenda-setting tool
to help patients prepare for their visit.
It allows patients and their families
to become more fully engaged in their medical appointments
by sharing important information
that will assist in finding an accurate
and timely diagnosis.
The note sheet aims to solicit
key information from patients,
including why they are at the visit;
what, if any, changes in their health they've had
since their last visit;
questions they may have about tests, treatments, medicines,
or other health considerations;
whether they have seen any other health providers;
and a final question to help patients share
what's really on their minds,
what's concerning them about their health.
When this note sheet was pilot tested,
providers noted that the "What are you worried about?"
question elicited important information from patients
they might not have otherwise shared.
It's important for all staff and providers
to be familiar with the note sheet
and be ready to help patients if they need it.
Now let's look at the provider-facing strategy.
Studies show that patients are interrupted
by their providers in the first 11 to 18 seconds
of telling their story.
Deep and reflective listening
is a component of mindful medical practice
grounded in the adage that the patient's story
begins the diagnostic process.
But even the best communicators and diagnosticians
can fall short when they are faced with a huge patient panel
and a busy schedule with competing administrative
and clinical demands.
The goal with the 60 Seconds To Improve Diagnostic Safety
strategy is to practice deep and reflective listening
for one minute at the start of the encounter.
Allowing the patient to tell his or her story
without interruption gives providers the opportunity
for a diagnostic pause,
a point in the encounter where providers can reflect
on the information the patient is sharing,
coupled with the information from the medical record
and direct observation.
In this way, providers can pick up on contextual cues
that aid in establishing a working diagnosis
or identifying when the patient's chronic health condition
may have changed.
With the 60 Seconds To Improve Diagnostic Safety strategy,
providers first listen, then ask questions
that deepen understanding,
and avoid jumping prematurely to advice or judgments.
This approach helps prevent premature closure
and anchoring biases that can lead to diagnostic errors.
The next few slides
are dedicated to reviewing practical materials
that were developed as part of the Toolkit
for Engaging Patients To Improve Diagnostic Safety
that will assist practices in implementing
the two strategies.
The Toolkit Implementation Roadmap
is available on the AHRQ website.
This roadmap is the starting point for implementation
and helps with planning.
Early stakeholder engagement is critical
to any successful implementation.
The Toolkit contains an infographic,
which provides statistics about the incidence
of diagnostic errors.
The infographic can be useful to engage leadership
and raise awareness of the problem.
This webinar can also be used to orient key stakeholders
to the Toolkit and how it can be implemented.
As part of the Toolkit,
two planning worksheets are available
to help teams plan for implementation
of the paired strategies:
The Be The Expert on You Planning Worksheet
and the 60 Seconds To Improve
Diagnostic Safety Planning Worksheet.
Each worksheet provides practical questions and guidance
that can help local practice champions
establish effective scope, workflow, adoption,
and use of the strategies.
The Toolkit includes several helpful training materials
to facilitate implementation.
A one-page handout for staff training
can help staff become comfortable
with introducing the Be The Expert On You
note sheet to patients.
A short slide presentation with speaker notes
can help train providers on how to listen deeply
for 60 seconds to cultivate presence, attentiveness,
and curiosity during the patient encounter.
Finally, the Practice Orientation and Training Slides
can be adapted with site-specific implementation plans
and used to orient and train everyone in the practice.
Here are some helpful tips to consider
as you begin using the Toolkit for Engaging Patients
To Improve Diagnostic Safety within your organization.
Tip one, focus the intervention
on select patient populations.
For example, choosing patients who are coming in
for acute or episodic clinic visits
or new problems may be a good place to start.
Tip two, it might be helpful to give the patients
the note sheet after they finish
all other pre-visit paperwork.
This approach will help the note sheet stand out
from the other papers
and allow patients to keep it with them
during their encounter.
Tip three, some patients might have difficulty
completing the note sheet.
When rooming patients, either in person or online,
it's a good practice to quickly scan the note sheets.
If the page is blank,
ask patients if they might want some help
and take a minute to help them complete it.
This step works well for patients with low literacy.
Be sure to do this after the patient
is in the encounter room.
Tip four, providers may also use
the Be The Expert On You note sheet
to help prompt patients who may be slow to share
or to redirect patients whose stories go too long.
The note sheet can also be used to co-create a visit agenda,
aiding the patient and the provider
in organizing the visit and ensuring
questions and concerns get addressed.
What can you expect when implementing the Toolkit
for Engaging Patients To Improve Diagnostic Safety?
A reduced propensity for diagnostic errors,
which is linked directly to improvements in clear, concise,
correct, and complete information sharing from the patient,
improved relationships with patients,
leading to improved patient experience and patient safety,
an enhanced connection with patients
and reduced technical burnout,
and a return to the joy of healing.
The Toolkit also includes an evaluation planning tool
and patient and provider surveys.
These materials can help in evaluating the local impact
of the strategies on patients, providers, and practices.
Thank you for listening to this webinar on the Toolkit
for Engaging Patients To Improve Diagnostic Safety.
If you have any questions,
please contact the project team listed on the AHRQ website.