1. Diagnostic QI Repository
  2. SIDM-IHI Learning Collaborative

Northwell Health

About the Northwell Health Pilot Site Project

Project Leads: Bill Ruggiero, Jess Parada

Northwell, over six months, developed and deployed PDSA trials to reduce diagnostic errors within the Ambulatory (Community/Faculty Practices), Emergency Department (LIJMC) and Inpatient (Lenox-Adult/ Cohen-Pediatrics) clinical settings by focusing on the roles of the Patient, Family and Caregiver. They effectively carried out enhanced patient communication using a scripted “Teach-Back“ intervention in 507 trials during a five-month period of time. Providers were asked to explain a given diagnosis to a patient and have the patient repeat back what they understood about their diagnosis/diagnoses at the end of the encounter. On the basis of the defining Diagnostic error as: “The failure to (a) establish an accurate and timely explanation of the patient’s health problem(s) or (b) communicate that explanation to the patient”, the team predicted that Teach-Back employed routinely during the patient encounter in an effort to improve communication would decrease diagnostic error. The effectiveness of this approach was measured utilizing Exit Surveys to elicit the following data points: 1) Did patients receive the intervention as designed? That is, did patients perceive they were being engaged in an enhanced-communication intervention? 2) Did patients respond positively to the intervention? 3) Were patients able to demonstrate a clear understanding of their diagnosis/diagnoses following the intervention? Future quality improvement initiatives surrounding patient engagement could utilize Press-Ganey’s patient satisfaction metrics to gauge longer-term improvement trends.