The Pursuit of Diagnostic Excellence

One of Children’s Hospital Association’s (CHA) key missions is supporting improvements within pediatric hospitals that save children’s lives. We hope a recent pilot study, co-led by CHA's Quality Improvement team and Child Health PSO®, will do just that. The study, which won an industry award for best abstract, is one example of how collaboration empowers progress toward eliminating preventable harm.

The Child Health PSO analyzes hundreds of patient safety cases per year, and diagnostic errors consistently rank among the top causes of serious safety events. In 2020, the Child Health PSO disseminated a toolkit for diagnostic safety designed to be used anywhere in an organization and with any diagnosis. Although the toolkit was developed with safety leaders working in children’s hospitals, we wanted to understand its usability and value using a quality improvement (QI) approach. Measuring improvement in diagnostic safety is highly complex, and it’s rare to find a study validating practical interventions.

To do this, the Child Health PSO partnered with CHA’s QI team to test one essential component of the toolkit: the diagnostic timeout. Diagnostic timeouts are pauses in patient care where all members of the care team come together to reevaluate the patient’s diagnosis and medical response to treatment using a specific list of prompts.

“You have to start somewhere to iterate and learn. Even with all the discussions around diagnostic safety, there are not many applied interventions like this in the literature. We’re changing that,” said Elise Buckwalter, CHA’s clinical quality improvement consultant, co-led the study with Director of Child Health PSO Emily Tooley.

As one of the first to test an applied intervention in pediatric diagnostic safety, the pilot was awarded Best Abstract for Applied Innovation at the Diagnostic Excellence 2024 Conference. This achievement was made possible by combining the learnings and resources of the PSO, the improvement expertise of our QI team, and the passion and dedication of the participating children’s hospitals.

Two distinct aspects of our timeout set it apart:

• Team-based approach. The Child Health PSO diagnostic toolkit recommends using a multidisciplinary team, including the patient and their family. This ensures all the information from all relevant angles is accounted for. One of the most interesting findings from the pilot study is that hospital staff saw the most value in a timeout when nurses and the patient and family were included.
• Enhanced communication. Data submitted to the Child Health PSO prompted the toolkit’s creation when more than half of the reporting children's hospitals noted communication among the care team as a top contributor to diagnostic errors. The timeout gives hospitals a practical tool to address this pervasive challenge, including questions to ask, triage cues to consider, and steps for evaluation.

All hospitals are at different points in their diagnostic safety journey. For some, implementing timeouts and learning from their peers may be the first step towards developing a diagnostic safety program. For others, standardizing a process for a multidisciplinary timeout at a specific moment in a patient’s stay enhances their existing diagnostic safety work by ensuring consistency and decreasing the likelihood of errors.

We hope this pilot not only demonstrates that improvements in diagnostic safety are possible, but also points to collaboration as the key to achieving diagnostic excellence for all children. We look forward to future studies that advance patient quality and safety made possible by the unique partnership of our Quality Improvement and the Child Health PSO teams.

View the Child Health PSO diagnostic safety toolkit.