FIVE TAKEAWAYS
REDUCING HARM BY GETTING PATIENTS THE RIGHT DIAGNOSIS AT THE RIGHT TIME
Improving diagnosis represents a moral, professional and public health imperative, according to the National Academy of Medicine.
A webinar on September 25 brought together an esteemed panel of experts, including Paul Epner of the Society to Improve Diagnosis in Medicine, David Newman-Toker of the John Hopkins Armstrong Institute Center for Diagnostic Excellence and Dana Siegal from CRICO Strategies, to discuss the prevalence and drivers of diagnostic error, as well as how to improve diagnosis in clinical settings.
Drivers of diagnostic errors can be attributed to failures in clinical judgement, communication and/or an error within a clinical system.
Clinical reasoning failures, such as not ordering the right diagnostic test or identifying the relevant symptoms of a patient, contribute to 86% of diagnostic claims, while 35% of claims involve failure in provider communication, such as not reading medical records. Sometimes patients do not receive the right results, or they delay completing tests; contributing to 22% of diagnostic errors. Problems with EHRs can also lead to diagnostic error through poor coordination between different record-keeping systems, copypaste errors or information overload.
Teamwork, training, technology and tuning will help transform diagnostic performance.
Making patients, nurses and allied health professionals part of the diagnostic team breaks down communication barriers. Computer-based simulations during training will enable physicians to more accurately diagnose. Through the adoption of telemedicine, technology will play a significant role in stopping misdiagnosis. Lastly, fine-tuning-diagnostic performance through case feedback and outcomes will lead to a better calibrated, learning health system.
About 12 million Americans will experience a diagnostic error each year, some with devastating consequences.
Diagnostic errors can be catastrophic for patients, sometimes resulting in permanent disability or even death. Each year in the U.S., the failure to establish an accurate and timely explanation of a patient’s health problem or to communicate that problem effectively leads to at least 40,000 to 80,000 hospital deaths. This critical public health problem has remained a blind spot in the delivery of healthcare. The societal costs of misdiagnosis are estimated to be more than $100 billion per year.
The latest research suggests that vascular events, infections and cancers lead to most of the serious harms from diagnostic error.
These three big categories—vascular events like stroke and aortic aneurysms; infections like sepsis, meningitis and pneumonia; and cancers such as lung, breast and melanoma—make up 75% of all diagnostic errors resulting in serious harms, about half of which are deaths and the other half serious, permanent disability.
Diagnostic errors are the most common, catastrophic and costly of serious, high harm, medical errors in malpractice claims.
New research, examining malpractice claims over 10 years, finds that 34% of serious harms from medical error are diagnostic errors—the most common error in these claims. Nearly two out of three of these claims (64%) are associated with death or permanent disability, and they make up 28% of total payouts for all medical malpractice claims. The subset of diagnostic error claims analyzed in this study accounted for $2.65 billion in payouts over 10 years, and the national total over that period was roughly $9 billion.