Patient safety experts say the Institute of Medicine's new report on reducing diagnostic errors is a "major milestone" in the effort to improve diagnoses, save lives and advance care.
The report, "Improving Diagnosis in Health Care," outlined eight strategies that all healthcare stakeholders can follow to prevent these widespread errors, which researchers said will impact most patients at least once in their lifetime. The research is a follow-up to the 1999 landmark report, "To Err is Human: Building a Safer Health System," and "Crossing the Quality Chasm: A New Health System for the 21st Century" in 2001. Although both those reports mentioned diagnostic errors, they didn't include specific actions or recommendations to address them.
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"Surprisingly, there's been little attention paid to the issue in the interim," said John R. Ball, chair of the Committee on Diagnostic Error in Health Care, which conducted the latest research, during a briefing Tuesday to announce the findings. Yet, he said, diagnostic errors persist through all settings of care. Every piece of research the committee examined indicated diagnostic errors were consistent problems. The bottom line, he said, is that "most of us will experience at least one diagnostic error in our lifetime."
But in order to reduce misdiagnosis, he said the committee believes the industry must focus on improving the diagnostic process. It calls on more effective teamwork among clinicians and patients; improved training and education for healthcare professionals; a payment and care delivery environment that supports the diagnostic process; improved health IT; voluntary reporting of diagnostic errors; and a dedicated focus on new research
"This report addresses a significant gap in our knowledge," Paul Epner (pictured), executive vice president of the Society to Improve Diagnosis in Medicine (SIDM) and chairman of the newly formed Coalition to Improve Diagnosis, said in a prepared statement. He said the SIDM plans to drive the review of recommendations and actions across the entire healthcare system.
Mark Graber, M.D., founder and president of SIDM and a member of the report committee, referred to the research as a "major milestone in the effort to improve diagnoses, quality of care and patient outcomes" and meet a patient's expectations of timely, accurate and efficient diagnosis.
Epner said the report's recommendation to make diagnosis a "team endeavor" that involves patients, as well as clinicians and laboratory and radiology diagnostic professionals, is a key strategy to ultimately reduce near-misses and mistakes. "Education reform is another key element, so that trainees learn mechanisms to reduce diagnostic errors in practice," Epner said. "Finally, for a problem that may be as lethal as traffic accidents, diabetes, or AIDS, research funding on the causes and potential solutions is urgently needed."
Kedar Mate, M.D., (pictured left) senior vice president with the Institute for Healthcare Improvement, told FierceHealthcare that the 1999 "To Err is Human" report focused attention on patient safety in hospitals and health systems. He thinks the latest report will help encourage patient safety initiatives in the ambulatory setting.
"When you walk into a physician's outpatient practice, most patients don't think of it as an opportunity for great harm to befall them," Mate said. Yet, he said, the chance of error is great because a provider could prescribe the wrong medication, fail to order a necessary test, miss a diagnosis or fail to make the necessary referral to a specialist. "I think this report can potentially help us reframe the risks and harms in the ambulatory setting and improve the care setting," he said.
In order to begin addressing the problem, he recommends providers first assess their current systems to determine how reliable they are for managing, tracking and communicating test results. They can then begin the journey to make improvements once they understand the weaknesses of these systems, he said.
Art Papier, M.D., a practicing physician who also serves as associate professor of medical informatics and dermatology at the University of Rochester College of Medicine, told FierceHealthcare he is pleased that the IOM has focused on diagnostic errors that until now have been left off the quality and safety agenda. Even if the diagnostic error rate was actually as low as 5 percent, he said, it would translate to more than 18 million diagnostic errors in primary care each year.
"It is obvious to patients that doctors (and nurse practitioners and physician assistants) cannot memorize it all," Papier said. "Yet many physicians and clinicians practice from memory. They memorize the most common and most serious and they 'rule these diseases in, or rule them out.' Physicians ask patient history questions based on their personal expertise and what they remember, by definition they cannot ask questions about the diagnoses they don't know. This sets up a self-fulfilling prophecy where more common diagnoses are made, and variants of the common and rare diagnoses are missed."
To learn more:
- read the SIDM statement