Leapfrog Group's interest in diagnostic safety

Mark Graber mark.graber at IMPROVEDIAGNOSIS.ORG
Tue Aug 9 13:04:55 UTC 2016


Maureen - thanks for asking about referrals; its an interesting topic and one that needs a LOT more thought and research.  The "Choosing Wisely" campaign was focused on ineffective and wasteful care, and you can ask most any specialist about all the consultations they get they believe are inappropriate for problems that could\should have been handled by the primary care clinician.  Probably some of these complaints are justified and probably some are not, but let's call these the 'over-referral' problem.  The key question here is whether the primary care clinician just didn't take the time to deal with the problem, or really doesn't have the knowledge base and wherewithal to deal with the problem appropriately.

I believe you are asking about the opposite problem, under-referral, and my personal opinion is that this is a much larger quality issue, and leads to more harm, than over-referral.  Fresh eyes catch mistakes, and almost by definition the odds of receiving the right diagnosis are going to be best if you are seeing an expert.  Projects that link patients to the right expert in a timely manner have great promise for reducing diagnostic errors and error-related harm.  The challenge is how to accomplish that.


Mark L Graber MD FACP
President, SIDM  www.improvediagnosis.org
Senior Fellow, RTI International
Professor Emeritus, SUNY Stony Brook, NY
919 990-8497


On Aug 8, 2016, at 7:26 AM, Maureen Cahill <MCahill at NCSBN.ORG> wrote:

Hi Mark, as part of our work in the practice group discussing diagnostic error we are looking further at referral – has anyone to your knowledge discussed a “referring wisely” campaign?  I know it would be an uphill battle to decide guidelines, etc. but it seems a number of closed claims related to diagnostic issues are delay of appropriate referral and there is a good deal of anecdotal discussion about inappropriate referral. 
Maureen
 
Maureen Cahill [Associate] 312.525.3646 (D) mcahill at ncsbn.org <mailto:mcahill at ncsbn.org>
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From: Mark Graber [mailto:graber.mark at GMAIL.COM <mailto:graber.mark at GMAIL.COM>] 
Sent: Saturday, August 6, 2016 6:56 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG <mailto:IMPROVEDX at list.improvediagnosis.org>
Subject: Re: [IMPROVEDX] Leapfrog Group's interest in diagnostic safety
 
The Leapfrog program on diagnostic error (the slides and an audio recording) can be found here:  There is also a copy of the survey if anyone is interested.
 
Mark 
 
 
http://www.leapfroggroup.org/survey-materials/town-hall-calls <http://www.leapfroggroup.org/survey-materials/town-hall-calls>
 
 
 
 
On Aug 5, 2016, at 1:36 PM, harry wingate <wingateh at bellsouth.net <mailto:wingateh at bellsouth.net>> wrote:
 
Is there a link to the recording of the teleconference?
 
Thanks
 
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On Friday, August 5, 2016 1:01 PM, Mark Graber <graber.mark at GMAIL.COM <mailto:graber.mark at GMAIL.COM>> wrote:
 

The Leapfrog Group <http://www.leapfroggroup.org/>, an active member of the Coalition to Improve Diagnosis <http://www.improvediagnosis.org/?page=CID>, is considering a potential future standard regarding diagnostic error on its annual survey of its 1800 member hospitals and organizations.  This past month they sponsored a national teleconference on diagnostic error, presented by David Newman-Toker MD PhD and Mark L Graber, MD.  
 
As part of this program, Leapfrog is encouraging their member organizations to participate in a SIDM survey that will provide hospitals with a ‘check-up’ of where they are at culturally and structurally in their efforts to monitor and reduce diagnostic errors within their hospital.  The SIDM survey will help SIDM and Leapfrog understand the barriers that hospitals are facing in making progress in this important patient safety area.

If your organization is a member of the Leapfrog group, please encourage them to participate in this first-of-its-kind, 10 minute survey:
 
https://jhmi.co1.qualtrics.com/SE/?SID=SV_aXD65JbOsyhpJMp <https://jhmi.co1.qualtrics.com/SE/?SID=SV_aXD65JbOsyhpJMp>
 
 
Mark L Graber MD FACP
Senior Fellow, RTI International
Professor Emeritus, SUNY Stony Brook
President Society to Improve Diagnosis in Medicine (SIDM)
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Moderator:David Meyers, Board Member, Society for Improving Diagnosis in Medicine

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Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine


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