Discussions during handoffs could help hospitalists avoid diagnostic errors

A better review process at handoff may help hospitalists perfect their diagnostic skills and reduce medical misdiagnoses, according to an article published by Medscape.

Andrew Olson, M.D., from the University of Minnesota Masonic Children's Hospital and Benji Mathews, M.D., from Regions Hospital in St. Paul described the review process this week at the Society of Hospital Medicine 2016 Annual Meeting in San Diego, according to the article.

The plan calls for members of the medical team to discuss the patient's diagnosis, whether the diagnosis has changed and why during the handoff. In addition to helping patients get better care, the plan can help physicians gauge the keenness of their diagnostic skills.

The review may include the time of day a diagnosis was made and what preceded it--information that may allow hospitalists to determine whether certain factors affect the way they diagnose, according to the article. "You can know your batting average on Tuesday afternoons against left-handed pitchers when the temperature is below 70 degrees. But I wonder how good I am at diagnosing pneumonia. I don't know," Olson told the publication. "I think we should know how good we are."

Matthews said that peer coaching and review sessions between new and experienced physicians "can help you with your blind spots."

Medical misdiagnosis is a serious problem. There is currently very little data available, but a 2015 whitepaper by the Institute of Medicine (IOM) said that most patients will suffer a misdiagnosis in their lifetime, sometimes with fatal consequences. A 2014 study estimated that 12 million Americans receive a medical misdiagnosis each year.  

Misdiagnosis or a delay in diagnosis also drives claims against hospitalists, according to a second Medscape article

Research by medical malpractice insurers The Doctors Company examined 464 claims filed against 2,100 hospitalists between 2007 and 2014 and found that 36 percent of the claims were related to diagnoses, including missed, late or incorrect diagnoses. And, of those claims, the report said 35 percent resulted from an inadequate initial assessment, "consequently decreasing the chance that the hospitalist would arrive at the correct diagnosis."

To learn more:
- read the first and second Medscape articles
- here's the closed claims study (.pdf)