Fellowship in Diagnostic Excellence Program Award from the Society to Improve Diagnosis in Medicine (SIDM)

A major contributor to the high rate of diagnostic errors is that clinicians are not aware of errors when they occur. Handoffs have been recognized as sources of potential hazard especially when the information is incomplete, inaccurate or misinterpreted.1,2 Care transitions are inherent to the practice of hospital medicine in providing continuous care for hospitalized patients but also represent opportunities for error recognition and improvement as one clinician reviews and revises the plan established by another. Colleagues at Northwestern Memorial Hospital have studied discontinuity and have been surprised that, in some analyses, readmissions were lower with greater discontinuity. We hypothesize that discontinuity can provide a second opinion about clinical decisions. I wish to leverage the handoff of patients to: 1. Describe how often changes in clinical plans occur at transitions 2. Provide Feedback to hospitalists when clinical decisions are changed. 3. Develop a better understanding of the natural history of the changes in diagnosis that occur in the context of a modern hospitalization.