Diagnosis Error:  The Last Gap in Patient Safety

Medical | Donald H. Bauman, Jr. | May 30, 2018

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Don Bauman, CEO of Isabel Healthcare, explores the benefits of reducing medical errors in patient care, and the critical area that still needs to be addressed — diagnosis error.

Reducing medical errors is good for patient care, improving outcomes and reducing costs. There have been tremendous advances in reducing medication errors, wrong site surgeries, hospital associated infections and other adverse events, yet one key area that has been left behind is diagnosis error. 

Why is Diagnosis Error important?

A correct differential diagnosis is the first decision made about the patient that determines all subsequent treatment. A delayed or inappropriate diagnosis can lead to unnecessary care, costs and burden to the patient and in some cases, it can be fatal.

How is Diagnosis Error being addressed?

The road to tackling diagnosis error is rapidly changing with multiple organizations confronting the issue. 

  • The Society to Improve Diagnosis in Medicine (SIDM) has spurred significant interest in understanding the root cause of diagnosis error and leading change to improve diagnoses and eliminate harm from diagnosis error. SIDM has spearheaded the formation of The Coalition to Improve Diagnosis. Members of the Coalition represent hundreds of thousands of healthcare providers and patients, leading health organizations and government agencies who work together work to find solutions which enhance diagnostic safety and quality, reduce harm and ensure better outcomes for patients.
  • The ECRI Institute announced diagnostic errors as a top concern within its 2018 Top 10 Patient Safety Concerns for Healthcare Organizations report. The ECRI Institute is an independent non-profit organization which dedicates itself to applying scientific research to discover which medical processes, devices, procedures and drugs are best and to improve patient care. The ECRI Institute serves 5,000 members and clients include hospitals, health systems, public and private payers, as well as U.S. federal and state government agencies, health clinics, patients, policymakers and ministries of health.

ECRI Institute’s 2018 list of patient safety concerns are listed below:

  1. Diagnostic errors
  2. Opioid safety across the continuum of care
  3. Care coordination within a setting
  4. Workarounds
  5. Incorporating health IT into patient safety programs
  6. Management of behavioral health needs in acute care settings
  7. All-hazards emergency preparedness
  8. Device cleaning, disinfection and sterilization
  9. Patient engagement and health literacy
  10. Leadership engagement in patient safety

A delayed or inappropriate diagnosis can lead to unnecessary care, costs and burden to the patient and in some cases, it can be fatal.

The list identifies the top concerns that have appeared in the ECRI Institute member’s inquiries, their root cause analyses, and in the adverse events submitted to their Patient Safety Organization (PSO).  ECRI Institute PSO has received two million event reports and reviewed hundreds of root-cause analyses since 2009.

Reviewing their top concern of diagnosis error, ECRI Institute declared, “Each year approximately 1 in 20 adults experience a diagnostic error, according to published studies. These errors and delays can lead to care gaps, repeat testing, unnecessary procedures and patient harm.” 

Gail M. Horvath, MSN, RN, CNOR, CRCST, a patient safety analyst at the ECRI Institute, went on to say that “Diagnostic errors are not only common but can have serious consequences. A lot of hospital deaths that were attributed to the normal course of disease may have been the result of diagnostic error.”

Need for Diagnosis Support

The recommendations from the ECRI Institute includes using structured tools and algorithms to overcome cognitive biases that leads to errors. Organizations can capture data when errors or near misses occur, which they can then use to learn from the errors. Horvath also mentioned clinical decision support interventions can flag incidental findings that require follow-up and identify tests which have not been done.

The Future of Diagnosis

While diagnosis error has received little attention in the patient safety field until recently, great strides have been made in the past four years. Solving diagnosis error is not a simple task, as there are environmental, cognitive and system errors that may play a role in leading to a diagnosis error or delayed diagnosis. One specific actionable step that can be implemented today is encouraging the use of digital tools available to help clinicians with their differential. They are increasingly accessed in the clinician’s workflow inside the EMR.  Clinicians can research clinical features, find accurate evidenced based information about diagnoses and engage with each other collaboratively to reach a differential diagnosis.  An accurate differential diagnosis will lead to a correct final diagnosis. 

Isabel Healthcare actively participates in the movement to decrease diagnosis error by providing an enhanced deep learning differential diagnosis generator for clinicians, the Isabel DDx Generator. It is great to see diagnosis error receiving the attention it deserves within the patient safety and healthcare organizations. You can learn more in our white paper about improving the quality of diagnostic decision making and by accessing our information on diagnosis error.

Find out More About Isabel

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Donald H. Bauman, Jr.
Chief Executive Officer, Isabel Healthcare USA

Mr. Bauman joined Isabel in April 2010 and brought with him more than 30 years of experience in healthcare software sales and marketing activities. In his recent tenure in healthcare safety solutions, Mr. Bauman has served as vice president of sales and marketing for InformMed, a provider of innovative medication safety solutions, LMS Medical, a leading provider of obstetrical decision support solutions, and Cereplex Inc., an early stage market innovator in automated infection prevention solutions. He currently serves on the board of Better Day Health, an innovative EMR company.  His experience includes direct sales, numerous area and national sales leadership roles, product marketing and partnership development at Premier, Inc., Bridge Medical, McKesson, CliniCom and Community Health Computing. Mr. Bauman holds a Bachelor of Science degree from the University of Michigan.

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