Comment period on AHRQ Prototype Patient Safety Reporting System

Von Feldt, Joan M. Joan.VonFeldt at VA.GOV
Thu Jun 13 18:08:08 UTC 2013


HI Mark
I think it is difficult to determine if this patient questionnaire could capture all types of diagnostic error.  One way to look at it is to think of the common cognitive biases and dx errors and work backwards

In our experience, the "unpacking bias" is pretty common with complicated patients and I don’t think this is sufficiently spelled out in the form- either in the communication or coordination of care set of questions.(see questions below)  I would suggest adding another bullet to say something like
The doctors did not review my complete records from the other medical center, or the doctors didn’t communicate with the other doctors that sent me here, or the doctors didn't use all the information from the other medical center/doctors

Another bias that we see is visceral bias, and there is no question with regard to that
Ie: the doctors didn't treat me with respect, or something to that effect

Re the definition of medical error
I added a clause that would include more diagnostic errors

A medical mistake or error is something that was done (or not done) by a health care provider that would be considered incorrect at the time it happened, or that led to a delay in correct treatment. Sometimes medical mistakes can result in harm or injury to the patient, but not every time.”



In your opinion, did any of the following lead to the mistake or negative effect? PLEASE CHECK ALL THAT APPLY.
PROGRAMMER NOTE: ALL CHECKED ITEMS SHOULD GET A CODE OF 1. ALL NON-CHECKED SHOULD DEFAULT TO “0”.

Communication with doctors, nurses or other health care providers

5.3.1 Was it because the doctors, nurses, or other health care providers…
□A did not listen to the patient?
□B did not explain things to the patient in the patient’s language?
□C used terminology the patient could not understand?
□D did not spend enough time with the patient?
□E spoke with an accent that was hard to understand?
□F ignored what the patient told them?
□G did not explain medications or their side effects?
□H did not explain follow up care instructions?

Responsiveness of staff

5.3.2 Was it because of not getting…
□A help as soon as the patient needed it?
□B a referral as soon as the patient needed it?
□C an appointment as soon as the patient needed it?
□D care as soon as the patient needed it?

Coordination of care

5.3.3 Was it because…
□A the doctors, nurses, or other health care providers were not aware of care that took place someplace else?
□B of the lack of follow up by the doctors, nurses, or other health care providers?
□C doctors, nurses, or other health care providers did not seem to work well together as a team?



-----Original Message-----
From: Graber, Mark [mailto:Mark.Graber at VA.GOV]
Sent: Thursday, June 13, 2013 11:37 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: Comment period on AHRQ Prototype Patient Safety Reporting System


Dear colleagues,

As many of you may know, AHRQ is supporting the development of a national reporting system that patients could use to identify their concerns. The prototype is just about ready to go, and AHRQ is accepting one final set of comments (by July 8th).  SIDM will be submitting a unified set of comments, and I’d really appreciate your input.  Thanks for your suggestions!

Mark


Here’s the 3 main issues:

1)  Their definition of error:   Does this adequately apply to diagnostic error?
“A medical mistake or error is something that was done (or not done) by a health care provider that would be considered incorrect at the time it happened. Sometimes medical mistakes can result in harm or injury to the patient, but not every time.”


2)  The questions the patient will be asked:   Are these 2 questions sufficient to identify, classify and study diagnostic error?

See the full questionaire at:
http://www.reginfo.gov/public/do/PRAViewIC?ref_nbr=201306-0935-001&icID=207255


3.1 Did the medical mistake or error involve any of the following? Please choose the one answer that fits best.
□A A mistake related to a medicine
 Medicines can include prescription or non-prescription medication, herbs, dietary supplements, vaccines, contrast dye or other injected medicines] à GO TO 3.1.1.1

□B A mistake related to a test, procedure, or surgery This includes tests that involve taking samples of skin or tissue, inserting tubes to examine internal parts of your body, or other tests involving blood, urine, or X-rays.] à GO TO 3.1.2.1

□C A mistake related to pregnancy or childbirth  This includes errors in diagnostic testing during pregnancy and errors during labor and delivery] à GO TO 3.2

□D A mistake related to a diagnosis or advice from a doctor, nurse, or other health care provider à GO TO 3.1.3.1

□E A mistake related to poor cleanliness or poor hygiene à GO TO 3.2

□F Something else, or more than one mistake [GO TO 3.1f1]


3.1.3.1 In your opinion, what was the mistake with the diagnosis or medical advice?


3)  The questions the physician will be asked:   Are the questions asked sufficient to classify and study diagnostic error?

http://www.reginfo.gov/public/do/PRAViewIC?ref_nbr=201306-0935-001&icID=207256


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