Improving Communication of Diagnostic Uncertainty to Families of Hospitalized Children
Project Lead: Trisha L. Marshall, MD, MSc
Project AIM(s): Increase family knowledge of key elements for diagnostic uncertainty (i.e., 1) presence of diagnostic uncertainty, 2) likely diagnoses, and 3) concerning clinical changes) from 30 to 90% by January 2023
Narrative Description:
One pervasive challenge throughout this work has been intermittent system-wide stressors that made it significantly harder to test interventions and, subsequently, to get well-reviewed and effective interventions into reliable use on our clinical teams. These system-wide stressors have included lingering impacts of the COVID-19 pandemic and more recently incredibly strained hospital resources and staffing with the “tripledemic” of RSV, COVID, and influenza resulting in increased numbers of children in our ED and admitted to our hospital. These challenges often delayed intervention testing due to difficulty asking already strained healthcare teams to add tasks to their day. It is also reduced the number of survey responses we got from our healthcare providers on their communication practices for our key elements of communication and their use of interventions we were attempting to implement through this work. Lastly, these systems stressors delayed some educational interventions we had planned to reinforce the use of our communication interventions, and these sessions will now be held after the official completion date for this work.
Standardizing communication is challenging given the variation in communication styles and needs at both the provider and patient/caregiver level. Improving communication cannot be reliant on a one-size fits all approach and communication tools and strategies must be designed to be adaptable to meet those different communication styles and needs and also a variety of clinical scenarios. At the time of this final report, we are still in process of completing our final interventions and data collection but do feel that this work has resulted in both generalizable learning and tools which can be adapted for use by others pursuing similar work.
Our team has greatly enjoyed participating in this grant program and have benefited from both the financial support for this work as well as learning from others within our grant cohort. I do think that in the future if funding and time allow, more in-person meetings as opposed to virtual summits would be helpful in fostering relationships amongst teams participating in the grant program.
Publications:
Young EE, Kane J, Timmons K, et al. Brief report: Improving communication of diagnostic uncertainty to families of hospitalized children. Diagnosis (Berl). Published online October 26, 2023. doi:10.1515/dx-2023-0088
Marshall TL, Limes J, Lessing JN. Clinical progress note: Diagnostic error in hospital medicine. J Hosp Med. 2024;19(1):53-56. doi:10.1002/jhm.13205
Diagnostic quality problem type, failure, or category (symptoms, observed problems, gaps in performance) addressed by the intervention
- Information gathering
- Information integration
- Information interpretation
- Establishing an explanation (diagnosis)
- Communicate the explanation to the patient
Root causes/causative factors addressed by the intervention
- Patient-clinician interaction (includes patient and family engagement)
- Workflow (includes testing, follow-up, and referrals)
- Knowledge gaps/inexperience
Setting of the diagnostic quality improvement intervention
- Ambulatory medical care setting (e.g., clinic, office, urgent care)