June 16, 2020
Patient safety experts Tejal Gandhi, M.D., and Hardeep Singh, M.D., have created a simple but comprehensive framework for understanding diagnostic error in the context of COVID-19. It includes eight categories of error that "span the entire continuum of care and have both systems-based and cognitive origins."

Dr. Gandhi says there is an urgent need to recognize and address diagnostic problems in real time. “It’s important to begin moving into solutions while also determining how to capture diagnostic error events. We don't want to spend six months designing the perfect mechanism for identifying events and lose that time in terms of prevention,” she says.

COVID-19 also demands that organizations accelerate implementation of proven solutions. Gandhi points out that changing an organization’s culture doesn’t have to be a slow process, especially if physician leaders model open and honest discussion of safety events: “Transparency, openness and helping people feel comfortable talking about these kinds of errors can happen tomorrow in organizations. That's the first step.”

As hospitals and medical practices begin to see more patients who postponed care over the last several months, Gandhi encourages her colleagues to be mindful of disparities in health care, including diagnosis. Some racial and ethnic groups have been disproportionately affected by COVID-19, and many communities of color include patients who have been chronically underserved. Gandhi says, “We have to constantly be looking for where we may be unintentionally widening the gaps.”

Many hospitals are examining changes made in response to the spring surge of COVID-19 patients and asking: What safety and other practices should we keep?

For Elizabeth Lydstone, R.N., Director of Maternal and Child Health at Lowell General Hospital, the crisis strengthened partnerships with the larger Lowell community and underscored the value of team nursing.

Lydstone and her staff have been working with social service providers, often together with language interpreters, on conference calls or in Zoom meetings to prepare mothers, partners and families for the hospital experience and discharge to home. They have been advising some patients, for example, on housing options. Lydstone reports that individuals grew closer as they collaborated on behalf of patients and families. She notes, “Our relationships became more respectful. You develop new appreciation for people when you depend on each other. Working so closely together, we were able to deepen our mutual trust. It's just an amazing feeling.”

Using care teams on COVID units reminded Lydstone of the principles of team nursing, a multidisciplinary approach to patient-centered care developed in the 1950s. She says the hospital needed “all hands on deck” to respond to the crisis, and that the newly formed teams delivered. The experience leads her to think, “Perhaps we should look beyond the scope of what we need today, keep some things, like these care teams, intact to increase and improve the way that we care for patients.”

Online learning
>> Compassion in Action : A virtual conference from The Schwartz Center for Compassionate Healthcare begins at 12:45 p.m. today, Tuesday, June 16 and continues with twice weekly sessions through November 17. For information and to register, click here.

>> Virtual town hall for patients on kidney transplantation during COVID-19: Hear from experts and a kidney transplant patient as part of a series of conversations about kidney care during the pandemic. Co-hosted by IPRO and the Betsy Lehman Center. Tuesday, June 23 from 6 to 7 p.m. For information on joining, click here .

Thank you, readers, for generously sharing stories about ways you are not just coping with COVID-19, but adapting and improving work along the way. We’d love to share even more of them in this newsletter. Please  let us know  about how your organization is managing challenges presented by the pandemic.