Leveraging diagnostic timeouts to foster interprofessional communication
-
James Bowen
,
Brenda Demeritt
Abstract
Objectives
Diagnostic errors are a significant source of patient harm, often arising from cognitive biases and communication breakdowns. Diagnostic timeouts (DTOs) offer a structured opportunity to reassess diagnoses, but their implementation is inconsistent. This study aimed to evaluate a nurse-driven DTO framework designed to enhance interprofessional communication and diagnostic accuracy in a pediatric hospital setting.
Methods
A multidisciplinary committee developed and piloted a DTO framework on a 48-bed pediatric acute care unit. Bedside nurses received structured education on DTOs, and standardized prompts were integrated into nursing workflows to identify patients who may benefit from a DTO. Feasibility and acceptability were assessed through voluntary surveys, post-DTO documentation, and qualitative feedback.
Results
Among 90 surveyed nurses, 28 % reported that a DTO would have been beneficial for at least one patient in the eight weeks prior to the intervention period. Over six months, 13 nurse-initiated DTOs occurred, with nearly half (46 %) prompting additional workup. Two DTOs led to escalation of care. Qualitative feedback highlighted improved communication, increased psychological safety, and enhanced teamwork.
Conclusions
Pilot implementation of a formalized nurse-driven DTO framework was well-received, reinforcing its role in structured diagnostic reassessment. Future efforts will expand DTO implementation and evaluate its impact on psychological safety.
-
Research ethics: Not applicable.
-
Informed consent: Not applicable.
-
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission. Author James Bowen was primarily responsible for drafting the work, and all authors made substantial contributions in revising it critically.
-
Use of Large Language Models, AI and Machine Learning Tools: None declared.
-
Conflict of interest: The authors state no conflict of interest.
-
Research funding: This work was not funded.
-
Data availability: The data that support the findings of this study are available from the corresponding author, JB, upon reasonable request. The data (including patient-related data) is not shared publicly due to privacy restrictions.
References
1. Committee on diagnostic error in health care, board on health care Services, institute of medicine, the national Academies of Sciences, engineering, and medicine. In: Balogh, EP, Miller, BT, Ball, JR, editors. Improving diagnosis in health care. Washington (DC): National Academies Press (US); 2015.Search in Google Scholar
2. Yale, S, Cohen, S, Bordini, BJ. Diagnostic time-outs to improve diagnosis. Crit Care Clin 2022;38:185–94. https://doi.org/10.1016/j.ccc.2021.11.008.Search in Google Scholar PubMed
3. Ladell, MM, Yale, S, Bordini, BJ, Scanlon, MC, Jacobson, N, Papautsky, EL. Why a sociotechnical framework is necessary to address diagnostic error. BMJ Qual Saf 2024;33:823–8. https://doi.org/10.1136/bmjqs-2024-017231.Search in Google Scholar PubMed PubMed Central
4. Children’s Hospital Association. Improving communication in the diagnostic process. 2021. [Internet] [cited 2024 Aug 12]. Available from: https://www.childrenshospitals.org/content/quality/alerts/improving-communication-in-the-diagnostic-process.Search in Google Scholar
5. Barwise, A, Leppin, A, Dong, Y, Huang, C, Pinevich, Y, Herasevich, S, et al.. What contributes to diagnostic error or delay? A qualitative exploration across diverse acute care settings in the United States. J Patient Saf 2021;17:239–48. https://doi.org/10.1097/pts.0000000000000817.Search in Google Scholar PubMed PubMed Central
6. Dietl, JE, Derksen, C, Keller, FM, Lippke, S. Interdisciplinary and interprofessional communication intervention: how psychological safety fosters communication and increases patient safety. Front Psychol 2023;14:1164288. https://doi.org/10.3389/fpsyg.2023.1164288.Search in Google Scholar PubMed PubMed Central
7. Romero-Brufau, S, Gaines, K, Nicolas, CT, Johnson, MG, Hickman, J, Huddleston, JM. The fifth vital sign? Nurse worry predicts inpatient deterioration within 24 hours. JAMIA Open 2019;2:465–70. https://doi.org/10.1093/jamiaopen/ooz033.Search in Google Scholar PubMed PubMed Central
8. McClintock, AH, Fainstad, T, Blau, K, Jauregui, J. Psychological safety in medical education: a scoping review and synthesis of the literature. Med Teach 2023;45:1290–9. https://doi.org/10.1080/0142159x.2023.2216863.Search in Google Scholar PubMed
9. Graber, ML, Kissam, S, Payne, VL, Meyer, AND, Sorensen, A, Lenfestey, N, et al.. Cognitive interventions to reduce diagnostic error: a narrative review. BMJ Qual Saf 2012;21:535–57. https://doi.org/10.1136/bmjqs-2011-000149.Search in Google Scholar PubMed
10. Griffith, PB, Doherty, C, Smeltzer, SC, Mariani, B. Education initiatives in cognitive debiasing to improve diagnostic accuracy in student providers: a scoping review. J Am Assoc Nurse Pract 2020;33:862–71. https://doi.org/10.1097/jxx.0000000000000479.Search in Google Scholar
11. Yale, SC, Cohen, SS, Kliegman, RM, Bordini, BJ. A pause in pediatrics: implementation of a pediatric diagnostic time-out. Diagnosis (Berl) 2022;9:348–51. https://doi.org/10.1515/dx-2022-0010.Search in Google Scholar PubMed
12. Sherbino, J, Dore, KL, Wood, TJ, Young, ME, Gaissmaier, W, Kreuger, S, et al.. The relationship between response time and diagnostic accuracy. Acad Med 2012;87:785–91. https://doi.org/10.1097/acm.0b013e318253acbd.Search in Google Scholar PubMed
13. Sauers-Ford, H, Statile, AM, Auger, KA, Wade-Murphy, S, Gold, JM, Simmons, JM, et al.. Short-term focused feedback: a model to enhance patient engagement in research and intervention delivery. Med Care 2021;59:S364–9. https://doi.org/10.1097/mlr.0000000000001588.Search in Google Scholar
14. Keniston, A, McBeth, L, Astik, G, Auerbach, A, Busch, J, Kangelaris, KN, et al.. Practical applications of rapid qualitative analysis for operations, quality improvement, and research in dynamically changing hospital environments. Jt Comm J Qual Patient Saf 2023;49:98–104. https://doi.org/10.1016/j.jcjq.2022.11.003.Search in Google Scholar PubMed
15. Douw, G, Schoonhoven, L, Holwerda, T, Huisman-de Waal, G, van Zanten, ARH, van Achterberg, T, et al.. Nurses’ worry or concern and early recognition of deteriorating patients on general wards in acute care hospitals: a systematic review. Crit Care 2015;19:230. https://doi.org/10.1186/s13054-015-0950-5.Search in Google Scholar PubMed PubMed Central
16. O’Donovan, R, Van Dun, D, McAuliffe, E. Measuring psychological safety in healthcare teams: developing an observational measure to complement survey methods. BMC Med Res Methodol 2020;20:203. https://doi.org/10.1186/s12874-020-01066-z.Search in Google Scholar PubMed PubMed Central
17. Adair, KC, Heath, A, Frye, MA, Frankel, A, Proulx, J, Rehder, KJ, et al.. The psychological safety scale of the safety, communication, operational, reliability, and engagement (SCORE) survey: a brief, diagnostic, and actionable metric for the ability to speak up in healthcare settings. J Patient Saf 2022;18:513–20. https://doi.org/10.1097/pts.0000000000001048.Search in Google Scholar PubMed PubMed Central
© 2025 Walter de Gruyter GmbH, Berlin/Boston
