Source: Institute of Medicine (IOM), iom.nationalacademies.org
Article referred by Justin Joseph, Best Doctors.Excerpts
Getting the right diagnosis is a key aspect of health care -- it provides an explanation of a patient's health problem and informs subsequent health care decisions. Improving Diagnosis in Health Care, a continuation of the landmark Institute of Medicine reports To Err is Human: Building a Safer Health System (2000) and Crossing the Quality Chasm: A New Health System for the 21st Century (2001) finds that 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: the committee concluded that most people will experience at least one diagnostic error in their lifetime, sometimes with devastating consequences.
Urgent change is warranted to address this challenge. Improving diagnosis will require collaboration and a widespread commitment to change among health care professionals, health care organizations, patients and their families, researchers, and policy makers. The recommendations from Improving Diagnosis in Health Care contribute to the growing momentum for change in this crucial area of health care quality and safety.
For decades, diagnostic errors--inaccurate or delayed diagnoses--have represented a blind spot in the delivery of quality health care. Diagnostic errors persist throughout all settings of care and continue to harm an unacceptable number of patients.
Improving the diagnostic process is not only possible, but also represents a moral, professional, and public health imperative. 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.
What is diagnostic error?• The committee defines diagnostic error as "the failure to (a) establish an accurate and timely explanation of the patient’s health problem(s) or (b) communicate that explanation to the patient."Diagnostic errors stem from many causes, including inadequate collaboration and communication among clinicians, patients, and their families; a health care work system that is not well designed to support the diagnostic process; limited feedback Improving the diagnostic process is not only possible, but also represents a moral, professional, and public health imperative.• It is estimated that 5 percent of U.S. adults who seek outpatient care each year experience a diagnostic error.• Postmortem examination research spanning decades has shown that diagnostic errors contribute to approximately 10 percent of patient deaths, and medical record reviews suggest that they account for 6 to 17 percent of adverse events in hospitals.• Furthermore, diagnostic errors are the leading type of paid medical malpractice claims and are almost twice as likely to have resulted in the patient’s death compared to other claims.Goals for ImprovementThe committee outlined eight goals to reduce diagnostic error and improve diagnosis• Goal 1: Facilitate more effective teamwork in the diagnostic process among health care professionals, patients, and their families• Goal 2: Enhance health care professional education and training in the diagnostic process• Goal 3: Ensure that health information technologies support patients and health care professionals in the diagnostic process• Goal 4: Develop and deploy approaches to identify, learn from, and reduce diagnostic errors and near misses in clinical practice• Goal 5: Establish a work system and culture that supports the diagnostic process and improvements in diagnostic performance• Goal 6: Develop a reporting environment and medical liability system that facilitates improved diagnosis by learning from diagnostic errors and near misses• Goal 7: Design a payment and care delivery environment that supports the diagnostic process• Goal 8: Provide dedicated funding for research on the diagnostic process and diagnostic errorsThe Diagnostic ProcessThe diagnostic process hinges on successful collaboration among health care professionals, patients, and their families. Patients and their families are critical partners in the diagnostic process. In addition, all health care professionals need to be well prepared and supported to engage in diagnostic teamwork.
ConclusionWithout a dedicated focus on improving diagnosis, diagnostic errors will likely worsen as the delivery of health care and the diagnostic process continue to increase in complexity. Just as the diagnostic process is a collaborative activity, improving diagnosis will require collaboration and a widespread commitment to change among health care professionals, health care 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 health care quality and safety.