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Sept. 22 — Few health-care organizations have processes in place to identify diagnostic errors and near-misses in clinical practice, and without a dedicated focus on improvement, these errors will likely worsen, according to a Sept. 22 study by the Institute of Medicine.
Data on diagnostic errors are sparse, few reliable measures exist and errors often are found in retrospect, the report said. To improve diagnosis and reduce errors, the report called for more effective teamwork and communication among providers, patients and families; more emphasis on identifying and learning from diagnostic errors and near-misses in clinical practice; a payment and care delivery environment that supports the diagnostic process; and a dedicated focus on new research.
According to the report, “diagnostic errors persist throughout all settings of care, involve common and rare diseases, and continue to harm an unacceptable number of patients. Yet, diagnosis—and, in particular, the occurrence of diagnostic errors—is not a major focus in health care practice or research.” Despite the paucity of data on errors, the report concluded that most people will experience at least one diagnostic error in their lifetime, sometimes with devastating consequences.
The report “is a serious wake-up call that we still have a long way to go,” IOM President Victor Dzau said in a statement. The IOM is a division of the National Academies of Sciences, Engineering, and Medicine.
According to the report, change won't come from a singular focus on improving diagnostic errors alone; it will require a broader focus.
Diagnostic errors stem from a wide variety of causes that include inadequate collaboration and communication among clinicians, patients and their families; a health-care work system ill-designed to support the diagnostic process; limited feedback to clinicians about the accuracy of diagnoses; and a culture that discourages transparency and disclosure of diagnostic errors, which impedes attempts to learn and improve, the report said.
“Errors will likely worsen as the delivery of health care and the diagnostic process continue to increase in complexity,” the IOM report said. To improve diagnosis, a significant re-envisioning of the diagnostic process and a widespread commitment to change from a variety of stakeholders will be required, the report said.
“The stereotype of a single physician contemplating a patient case and discerning a diagnosis is not always accurate, and a diagnostic error is not always due to human error. Therefore, to make the changes necessary to reduce diagnostic errors in our health care system, we have to look more broadly at improving the entire process of how a diagnosis made,” John R. Ball, chairman of the IOM research committee that wrote the report, said in a statement.
The research committee recommended that providers and other health professionals provide patients with opportunities to learn about diagnosis, as well as improved access to electronic health records, including clinical notes and test results. In addition, health-care organizations and professionals should create environments in which patients and families are comfortable sharing feedback and concerns about possible diagnostic errors, the report said.
Health-care quality stakeholders hailed the report as an important advancement.
The Society to Improve Diagnosis in Medicine (SIDM), which petitioned for the report to be produced, called the report “a major milestone in the effort to improve diagnoses, quality of care and patient outcomes.”
Paul Epner, executive vice president of SIDM, said the report “addresses a significant gap in our knowledge. It is the responsibility of everyone involved in the diagnostic process to consider the steps they can take to improve outcomes. This begins with healthcare providers and their organizations, which need to establish a culture of safety where these errors can be identified, studied, and addressed.”
The American College of Radiology (ACR), a sponsor of the report, congratulated the IOM committee on its recommendations for improvement. “Further minimizing diagnostic errors must involve patients and providers working together and leverage advancing technology to ensure safe, appropriate and accurate care,” Bibb Allen, chairman of the American College of Radiology Board of Chancellors, said in a statement. “It is also vital that patients understand their test results as well as the limitations of diagnostic exams.”
The ACR said it supports the IOM recommendation for new health-care delivery and payment systems that promote collaboration among physicians and other health-care providers, including consultations with radiologists.
“If we truly want a collaborative approach to patient care, health care systems need to encourage these interactions without penalizing providers for examining errors when they do occur. We are pleased to see the IOM recognize this,” Allen said.
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