Getting the right diagnosis is a key aspect of healthcare. It seems an obvious thing to say, but these days, busy physicians are also concerned with keeping a practice or hospital running, managing their increasing workloads (and increasingly overburdened schedules), and meeting a raft of new quality metrics. Sometimes, it’s easy for physicians to lose sight of why they pursued medicine: to help patients by explaining their health problems, and aiding them in getting the care they need.
Diagnostic errors: an overlooked problem
Almost every American will experience a medical diagnostic error, reports Kaiser Health News, but it’s become something of a blind spot in the world of patient-safety concerns. And that’s why the Institute of Medicine is trying to bring diagnostic errors — defined as inaccurate or delayed diagnoses — back into the spotlight.
The National Academies of Sciences, Engineering, and Medicine, with support from a broad coalition of sponsors, convened an expert committee to synthesize what is known about diagnostic error and propose recommendations to improve diagnosis. The result is “Improving Diagnosis in Health Care,” a continuation of the landmark Institute of Medicine (IOM) series that begin with the landmark “To Err Is Human.”
Understanding diagnostic errors
According to the report, diagnostic errors account for about 10% of patient deaths, hundreds of thousands of adverse events in hospitals each year, and are a leading cause of paid medical malpractice claims.
“Improving the diagnostic process is not only possible, but also represents a moral, professional, and public health imperative,” says the report. “Diagnosis — and, in particular, the occurrence of diagnostic errors — has been largely unappreciated in efforts to improve the quality and safety of health care. The result of this inattention is significant … sometimes with devastating consequences. Urgent change is warranted to address this challenge.”
According to the report, diagnostic failures begin when the patient isn’t engaged by the clinician. After that, failures in the diagnostic process occur in information gathering, integration and interpretation. As each of these failures occurs, the likelihood of an error increases — like a snowball rolling downhill, picking up more snow and speed, until it’s an inevitably destructive force.
Tackling diagnostic errors in healthcare
The key takeaway is that the IOM prescribes teamwork to avert these kinds of failures before they even occur. Some more of the report’s recommendations:
- In recognition that the diagnostic process is a dynamic team-based activity, healthcare organizations should ensure that healthcare professionals have the appropriate knowledge, skills, resources, and support to engage in teamwork in the diagnostic process. Patients and their families should also be empowered to participate in this teamwork.
- Ensure that health information technologies support patients and healthcare professionals in the diagnostic process. This means ensuring health IT is usable, incorporates human factors knowledge, integrates measurement capability, fits within the clinical workflow, provides clinical decision-making support, and facilitates timely flow of information between healthcare professionals, as well as to patients.
- Establish a work system and culture that supports the diagnostic process and improvements in diagnostic performance. To this end, healthcare organizations should (among other things) promote open discussion and feedback; design the work system in which the diagnostic process occurs to support the work and activities of healthcare professionals; and develop and implement processes to ensure effective and timely communication between diagnostic testing healthcare professionals and treating healthcare professionals across all care-delivery settings.
Moving toward an error-free diagnostic process
The theme is clear: Facilitating teamwork is critical to avoiding the failures in the healthcare process that lead to diagnostic errors. For example, including scribes in the care team would allow physicians to engage patients, and to minimize failures in information gathering, integration and interpretation. This in turn allows faster, more accurate communication of information to patients and other providers — thus maximizing the chances of an accurate, timely diagnosis. If all stakeholders are engaged, we can stop the diagnostic error ‘snowball’, even as the healthcare system continues to become more complex.
“Without a dedicated focus on improving diagnosis, diagnostic errors will likely worsen,” concludes the report. “Just as the diagnostic process is a collaborative activity, improving diagnosis will require collaboration and a widespread commitment to change among healthcare professionals, healthcare organizations, patients and their families, researchers, and policy makers. The committee’s recommendations contribute to the growing momentum for change in this crucial area of healthcare quality and safety.”