BACKGROUND: Hospitalists frequently work on diverse projects, but often do not have the training and experience necessary to translate projects into peer-reviewed publications and grants. OBJECTIVE: Describe implementation and effect of a works-in-progress (WIP) series on progress and training in scholarly work. DESIGN: Cross-sectional survey. SETTING: Urban academic medical center. INTERVENTION: A weekly WIP session, named Incubator, serving as a forum where researchers, clinicians, and educators meet to review and provide feedback on projects underway across the Division of Hospital Medicine. MEASUREMENTS: We surveyed presenters at Incubator to evaluate the impact of Incubator on scholarly activities. Responses were based on Kirkpatricks 4-level training hierarchy: (1) Reaction: participants satisfaction; (2) Learning: knowledge acquisition; (3) Behavior: application of skills; and (4) Results of projects. We compared responses between researchers and nonresearchers using χ2 tests. RESULTS: Of 51 surveys completed (response rate 70%), 35 (69%) projects were nonresearcher led. Reaction, behavior change, and results were all positive, with >90% respondents reporting a positive outcome in each category, a high rate of publication/funding, and 35% reporting learning as a result of Incubator. Comparison of researchers and nonresearchers revealed no significant differences, except nonresearchers reported significantly more favorable results in behavior and mentoring (P < 0.05). DISCUSSION: A regularly scheduled, researcher-led WIP session within a largely clinically oriented hospital medicine division can provide a venue for feedback that may promote progress and practical training in scholarly projects. In addition to robust career mentorship programs and protected time, a WIP can be an adjunct to improve scholarly output among academic hospitalists. Journal of Hospital Medicine 2016;11:719-723. © 2016 Society of Hospital Medicine.

Background

The COVID-19 pandemic required clinicians to care for a disease with evolving characteristics while also adhering to care changes (e.g., physical distancing practices) that might lead to diagnostic errors (DEs).

Objective

To determine the frequency of DEs and their causes among patients hospitalized under investigation (PUI) for COVID-19.

Design

Retrospective cohort.

Setting

Eight medical centers affiliated with the Hospital Medicine ReEngineering Network (HOMERuN).

Target population

Adults hospitalized under investigation (PUI) for COVID-19 infection between February and July 2020.

Measurements

We randomly selected up to 8 cases per site per month for review, with each case reviewed by two clinicians to determine whether a DE (defined as a missed or delayed diagnosis) occurred, and whether any diagnostic process faults took place. We used bivariable statistics to compare patients with and without DE and multivariable models to determine which process faults or patient factors were associated with DEs.

Results

Two hundred and fifty-seven patient charts underwent review, of which 36 (14%) had a diagnostic error. Patients with and without DE were statistically similar in terms of socioeconomic factors, comorbidities, risk factors for COVID-19, and COVID-19 test turnaround time and eventual positivity. Most common diagnostic process faults contributing to DE were problems with clinical assessment, testing choices, history taking, and physical examination (all p < 0.01). Diagnostic process faults associated with policies and procedures related to COVID-19 were not associated with DE risk. Fourteen patients (35.9% of patients with errors and 5.4% overall) suffered harm or death due to diagnostic error.

Limitations

Results are limited by available documentation and do not capture communication between providers and patients.

Conclusion

Among PUI patients, DEs were common and not associated with pandemic-related care changes, suggesting the importance of more general diagnostic process gaps in error propagation.