From Evidence to Intervention: A Systematic, Multi-Stakeholder Approach to Developing and Prioritizing Diagnostic Excellence Interventions Across a 14-Site Hospital Medicine Collaborative
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Background
Diagnostic errors are common and represent a leading cause of preventable harm in hospitalized medical patients. Despite growing recognition of this problem, the field lacks a systematic, evidence-based approach for developing, adapting, and selecting diagnostic excellence interventions at scale across multiple institutions.
Methods
Using a structured, multi-phase process, the Achieving Diagnostic Excellence through Prevention and Teamwork (ADEPT) collaborative, a 14-site AHRQ-funded hospital medicine network: (1) conducted an environmental scan of existing diagnostic safety practices across sites; (2) constructed a conceptual framework organizing potential interventions by target (patient, provider/team, health system) and safety paradigm (Safety I and Safety II); (3) convened multidisciplinary working groups to develop detailed proposals for six intervention programs; (4) applied a pre-specified multi-criteria rubric to facilitate group deliberation, and (5) voted to select a single high-priority intervention for collaborative launch.
Results
Six interventions were developed, selected, or adapted from prior work, spanning all cells of the target and safety paradigm framework. Finalized proposals were then shared at two separate ADEPT meetings – the first to solicit feedback on interventions and to coordinate activities across groups, and the second where a formal ranked-choice vote was held. This process resulted in selection of the Diagnostic Cross-Check (DXC) — a structured, peer second-opinion program triggered by rapid response team (RRT) events — as the highest priority intervention for collaborative-wide launch. The remaining interventions were designated as components of an ADEPT toolbox for future adaptation, adoption, and evaluation.
Discussion
The ADEPT collaborative’s systematic, evidence-informed approach to diagnostic intervention development offers a replicable model for other multi-site quality improvement networks. The resulting portfolio of interventions provides a roadmap for the field of inpatient diagnostic excellence.
