2024's @WHO World #PatientSafety Day focuses on #ImprovingDiagnosis. Here are 10 ideas to improve diagnostic safety at a #healthsystem + learn from (misdiagnosis/delayed dx) based on #experiments we did at the #SaferDX Learning Lab 2017-2022 at @GeisingerHealth.#WPSD2024 #WPSD24.

RT @JAMAInternalMed: A digital quality measure for advanced-stage cancer diagnoses was associated with higher rates of missed diagnostic op….

There is a weird type of distress when your worry moves beyond the emptiness in your chest and sort of twists your intestines or abdomen. I felt it when sandyhook happened. This AM its abt those kids in TX. Unbearable to imagine what's happening to those families right now.

#CMSQualCon25 .Re-upping - at the federal session, @CDCgov Dr Arjun Srinivasan just brought up diagnostic excellence/ diagnostic safety toolkits- here is a thread on the core elements he referenced + more resources.

"This is an administration that's serious about #patientsafety - open to early conversations about disincentivizing i.e. adjusting payment in case of safety/harm events" Dr Michelle Schreiber DD/CMO of CMS. "Stop paying for preventable harm". Well, need to know about them first?

@bsutariya - actually cautions quality & safety professionals- this- AI- is not bringing incremental change, you need to re-imagine how quality, safety will now be executed in health systems. Gives an eg of how stoke alerts resulted in dx in 2 mins instead of 20min using RapidAI.

@KedarMate @DBatesSafety @TGandhi_Safety make the point that in the world of Q&S, typically resource-limited, AI can help automate lot of the manual, regulatory abstraction so safety professionals can focus on true quality improvement, that matters.

@KedarMate Adds the recent Microsoft AI work that shows gen AI getting better at diagnosing - @bsutariya adds gen AI will move clinicians away from clinical pathways, complex CDS algorithms, take them to richer real time shared decision making.

@KedarMate re-emphasizes that for decades we've had 1 in 4 or 5 hospitalized patients injured in some way or the other- that statistic should be unacceptable. Talks about the role of AI in advancing safety for delayed dx, med reconciliation and patient safety event analysis.

@TGandhi_Safety adds why not focus AI measures on helping close the loop on abnormal test results not followed up appropriately (think delayed dx as in cancer etc) or for medicine reconciliation- known safety issues for years. Recommends AI should help #patientsafety personnel.

@TGandhi_Safety adds views-- look for trifecta- are these new tools (or any tools for that matter) - (1) designed safely, (2) can be safely implemented and (3) can be used safely - and will it eventually improve safety. This needs to be overseen by governance sensitive to culture.

The future is already here- its not very evenly distrubuted @DBatesSafety quotes william Gibson, .Says AI today can help improve dx in breast cancer and stroke through imaging AI (mammogram/CTs/MRIs). And sepsis as well.

Concept of "zero harm" has probably gotten in the way of truly tackling #patientsafety. It's imp to first acknowledge the burden of harm currently. With 1 in 10-15 in outpatient and 1 in 4 in inpatient setting experiencing adverse events, is too high @DBatesSafety #cmsqualcon.

- finally got into his element when he shared recent exp of his friend suffering from cancer & explained what patient centeredness means & how to care for those going through difficult times. Health systems shld exist for patients, not other way round.

Never miss a chance to listen to Dr @donberwick.Off late, he expresses optimism, positivity. But even i was getting impatient half-way through his msg -he profusely praised the incredible work done by CMS, (largest insurance company taking financial & social risk for 110M people).

@DBatesSafety @donberwick Lovely 2014 lecture by Dr Leape- outlines 3 obstacles to improving #PatientSafety .1) perverse financial incentives/FFS.2) "dysfunctional culture" that works for no1. 3) lack of genuine leadership in #Healthcare,lacks "will" to change culture. Still True!.

@DBatesSafety @donberwick Anyway, Dr. Leape - you leave legacy & inspiration behind. efforts of yours will be tragic if year after year we write about how stagnant and ignored #patientsafety is. World changed in the 4 decades since your paper. We ("systems") haven't. #RIP.

With @DBatesSafety & @donberwick they listed #patientsafety practices that can help- look at that list & see if you've been able to conquer this beast in 25 yrs. And then ask, why we failed. then, 20yrs later:

@donberwick For 4 decades. we have hesitated calling errors, errors. Even I force myself to sell the stuff in 2025 by labelling it "learning opportunities" - hoping it softens the blow & engages clinicians. NEJM rejected- JAMA published it. @Bob_Wachter (2006 iview)

In an editorial with @donberwick 20 yrs ago, he wrote "improvement of the magnitude envisioned by the IOM requires a national commitment to strict, ambitious, quantitative, and well-tracked national goals- set of explicit and ambitious goals for #patientsafety by . 2010. (!!!!)

Here's an i-view he gave @Bob_Wachter , where among other stuff, they discuss that tools are just tools - not helpful unless the embedded culture changes - for 25 yrs the answer hasn't changed- "culture". Culture doesn't change itself. @Atul_Gawande