Most people will experience at least one diagnostic error, an inaccurate or delayed diagnosis, in their lifetime, sometimes with devastating consequences, according to Improving Diagnosis in Health Care, a new report from the Institute of Medicine of the National Academies of Sciences, Engineering and Medicine.
To improve diagnosis and reduce errors, the committee that conducted the study and wrote the report called for more effective teamwork among healthcare professionals, patients and families, according to a news release. The report also suggests enhanced training for healthcare professionals; 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.
The report is a continuation of the IOM’s Quality Chasm Series, which includes reports such as To Err Is Human: Building a Safer Health System, Crossing the Quality Chasm: A New Health System for the 21st Century and Preventing Medication Errors.
Causes of errors
From the available evidence, the committee determined that diagnostic errors stem from a wide variety of causes that include inadequate collaboration and communication among clinicians, patients, and their families; a healthcare 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, said the release.
Errors likely will worsen as the delivery of healthcare and the diagnostic process continue to increase in complexity, the committee said. Critical partners in improving the diagnostic process are patients and their families, because they contribute valuable input that informs diagnosis and decisions about their care.
To help them actively engage in the process, the committee recommended healthcare organizations and 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, healthcare organizations and professionals should create environments in which patients and families are comfortable sharing feedback and concerns about possible diagnostic errors.
“These landmark IOM reports reverberated throughout the healthcare community and were the impetus for system-wide improvements in patient safety and quality care,” Victor J. Dzau, MD, president of the National Academy of Medicine, said in the release. “But this latest report is a serious wake-up call that we still have a long way to go. Diagnostic errors are a significant contributor to patient harm that has received far too little attention until now.”
The study was sponsored by the Agency for Healthcare Research and Quality, Centers for Disease Control and Prevention, American College of Radiology, American Society for Clinical Pathology, Cautious Patient Foundation, College of American Pathologists, The Doctors Company Foundation, Janet and Barry Lang, Kaiser Permanente National Community Benefit Fund at the East Bay Community Foundation and Robert Wood Johnson Foundation.