Recognizing excellence in diagnosis: Leapfrog's national pilot survey report (27 March 2024)

Summary

The US Leapfrog Group has released Recognizing excellence in diagnosis: Leapfrog’s national pilot survey report, which analyses responses from 95 hospitals on their implementation of recommended practices to address diagnostic errors, defined as delayed, wrong or missed diagnoses or diagnoses not effectively communicated to the patient or family. The National Academy of Medicine has warned that virtually every American will suffer the consequences of a diagnostic error at least once in their lifetime and noted that 250,000 hospital inpatients will experience a diagnostic error every year.  

While progress varies considerably, more than 60% of hospitals responded that they were either already implementing or preparing to implement each of 29 evidence-based practices known to prevent harm from diagnostic error. The practices were identified in an earlier Leapfrog report, Recognizing excellence in diagnosis: Recommended practices for hospitals. The hospitals reported barriers to putting the practices in place that include staffing shortages and budgetary pressure.  

Content

The report summarises findings from a diverse cohort of 95 top performing hospitals that volunteered for the pilot survey. They were not randomly selected, so findings are not generalisable to all hospitals. Nonetheless, the findings offer important insights on the progress among hospitals most interested in improving diagnosis and most successful at achieving excellence in other aspects of quality and safety. 

Key findings include: 

• Hospitals have made more progress in addressing issues in the diagnostic process than implementing leadership structures and systems to support improved diagnosis: On average, hospitals reported implementing 9 of the 16 practices (56%) in Leadership Structures and Systems and 8 of the 13 practices (62%) in The Diagnostic Process, despite practices concerned with The Diagnostic Process generally being more staffing- and resource-intensive. 
• Leapfrog’s goal of public reporting on diagnostic excellence resonated with hospitals: Hospitals that participated in the pilot survey agreed that the issue of diagnostic excellence is important and that public reporting is a fundamental precursor to any meaningful change. 
• Hospitals are receptive to tackling the problem of diagnostic error and exploring opportunities for improvement: For each of 29 recommended practices to address diagnostic error that hospitals were asked about, 60% or more hospitals responded that they were either already implementing or preparing to implement the practice. The average percentage of hospitals responding “Not Under Consideration” for a practice was 15%. 
• Progress varies considerably and full implementation is lacking: Most participants were open to the practices recommended by Leapfrog and were taking at least preliminary steps to implement them. However, attainment of full implementation was rare, and many practices were not being widely considered for adoption. 
• Hospitals need more specific guidance on improvement: Hospitals requested a hierarchical classification of practices that would describe a sequence of implementation. 

Further reading on the hub:

This year’s World Patient Safety Day on 17 September 2024 is focused on the theme “Improving diagnosis for patient safety”. Find out more.