UP FRONT

"COVID has laid bare the disparities in our society and health care system. The data speaks for itself. Disadvantaged communities are at increased risk of getting COVID-19 or experiencing severe illness, regardless of age."
— Gordon Schiff, M.D., Associate Director, Brigham and Women’s Center for Patient Safety Research and Practice


Two new articles highlight another challenge clinicians face with COVID-19: diagnostic error.

In a commentary for Diagnosis, Gordon Schiff, M.D. (subject of our Up Front interview), and Maria Miricia, Ph.D., who together lead the PRIDE (Primary Care Research in Diagnostic Errors) Learning Network, discuss potential sources of diagnostic error, including:

  • High rates of false negative and false positive test results
  • Bias related to high pre-test likelihood of COVID-19
  • Limited availability of information during telemedicine exams
  • Lapses in routine diagnostic and preventive care

To address these and other pitfalls, Schiff and Miricia recommend closing the loop on testing; rescheduling diagnostic evaluations deferred during early stages of the pandemic and applying the principles of conservative diagnosis.


And the Agency for Healthcare Research and Quality offers a primer on COVID-19 and diagnostic error that covers biases in the diagnostic process, including availability and anchoring, as well as effective strategies for testing in differing circumstances.


A new consensus study report from the National Academies of Sciences, Engineering, and Medicine discusses five ways to help develop and sustain new habits to fight the spread of coronavirus:

  1. Make the behavior easy to start and repeat
  2. Make the behavior rewarding to repeat
  3. Tie the behavior to an existing habit
  4. Alert people to behaviors that conflict with existing habits and provide alternative behaviors
  5. Provide specific descriptions of desired behaviors

These tactics emphasize positive action, avoid using fear to motivate, and can be applied to all public health efforts, including COVID-19.

The report offers examples for applying these principles to COVID-19 safety directives, such as positioning handwashing or sanitizing stations for easy access in medical office buildings. A message such as “Always wash your hands after putting down your keys” ties a new behavior to an existing habit. And the panel points out that most people find an explicit message, such as “maintain at least 6 feet of separation from others,” easier to follow than a vague recommendation to “socially distance,” something to consider when creating signage for your office or facility.

Warning that negative messaging may be counterproductive, the panel also offers
guidance for communicating effectively about behavior change. For example, disseminating photos and videos of crowded bars and beaches may normalize risky behavior. And, while it may seem counterintuitive, experts warn that efforts to counteract or debunk misinformation may have the unintended effect of reinforcing false beliefs.
Upcoming events

>> Building Connections: Peer Support as a Powerful Resource for Resilience, a free virtual workshop organized by the Betsy Lehman Center featuring Siobhan O’Neill, M.D. about resilience and using peer support to cope with the stress of providing care during COVID-19. It will be held on Thursday, August 20, 6:30 – 8:00 p.m. 

>> Mark L. Graber Diagnostic Quality Award from the Society to Improve Diagnosis in Medicine recognizes a person, group, or organization for important contributions to the reduction of diagnostic error. Deadline to submit nominations is Tuesday, September 1.

>> MACRMI’s annual Communication, Apology, and Resolution (CARe) Forum will be held online Monday, September 21, 2:00 – 4:00 p.m. The program is free and offers both CME and nursing credits to qualified attendees. 
You are receiving this email because you are subscribed to Patient Safety Beat or COVID-19 Safety News Briefs. With this issue, we are returning to a single periodic newsletter featuring articles about patient safety topics, including COVID-19, relevant to the Massachusetts health care community. Use the link in the the footer of this email if you would like to unsubscribe.

Patient Safety Beat is published by the Betsy Lehman Center, a state agency that uses communications, research, and data to catalyze the efforts of providers, policymakers, and consumers working toward safer health care in Massachusetts.