A focus on diagnostic error came at just the right time for Ruth Holloway, Director of Quality Management at Sparta Community Hospital. The hospital was intent on addressing diagnostic-related issues in early 2019, such as returns to the emergency department (ED) with a different diagnosis and delays in treatment.

Then last spring, Illinois Provider Trust (IPT)—professional liability services through IHA—urged its members to improve the diagnostic process through best practices. Many hospitals rose to the challenge, including Sparta, a Critical Access Hospital in rural southwestern Illinois.

Diagnostic error is a leading cause of patient harm. A blind spot in healthcare for decades, diagnostic error can result in death or significant patient morbidity, increased healthcare costs, and liability claims.

IPT’s annual Risk Exposure Adjustment Program offers member hospitals credit towards their annual contribution for improving care and reducing risk in specific areas. The program focuses on the diagnostic process again this year.

“You like to see the results, to improve,” Holloway said. “That’s always the key.”

Education and conversation were essential parts of Sparta’s efforts in 2019, including:

  • Discussing cases at ED and Med-Surg committee meetings, with follow-up emails to physicians;
  • Reviewing case studies IPT provided, which in one case led to a respiratory therapist providing inhaler education at its clinic; and
  • Soliciting input from the hospital’s Patient Family Advisory Council on a toolkit encouraging patients to take a more active role in their care.

“You have to not only look at what the physician is doing but the whole process and environment,” Holloway said. “[The program] helped us develop a common language and opened the door for suggestions to improve the diagnostic process.”