Improving Diagnostic Accuracy in U.S. Healthcare

What Hospitals and Health Systems Can Do to Make Diagnosis More Accurate and Timely

Making and communicating a medical diagnosis is a complex and imperfect science. Too often, patients get a diagnosis that is inaccurate or delayed, which can have devastating, lifealtering effects. In fact, one in three malpractice claims resulting in serious harm is due to misdiagnosis—making it the most common, catastrophic, and costly of serious medical errors. Improving diagnosis involves institutions, teams, processes, and individuals working together.

Why is your organization focused on misdiagnosis in healthcare?

PE: Research published this summer shows that misdiagnosis is the most common, catastrophic, and costly of all medical errors in malpractice claims that result in death or permanent disability (Newman-Toker, 2019). In fact, most Americans will experience a misdiagnosis in their lifetime, according to the National Academies of Medicine. We know that diagnosis, which by its very nature involves uncertainty, is one of the most difficult and complextasks in healthcare, and clinicians do remarkably well, yet the burden to patients is still substantial and requires attention. The Society to Improve Diagnosis in Medicine (SIDM) is the only organization focused solely on the problem of diagnostic error.

What can health systems and other provider organizations do to improve the diagnostic process?

PE: We’re beginning to understand where the diagnostic process is most likely to break down. For example, lapses in clinician judgement are responsible for many diagnostic errors. Such lapses include delaying or failing to order a diagnostic test; misinterpreting diagnostic clues provided by imaging, pathology, and lab tests; and not establishing a differential diagnosis. Communication and system failures are also major drivers of errors.

But clinicians cannot improve diagnosis alone. Care delivery organizations can take immediate steps to improve the diagnostic process. They can integrate patients and their families into the diagnostic process; opening new lines of communication may uncover clues in the patient’s history which could lead to the right diagnosis, sooner. They can make a concerted effort to identify and learn from diagnostic errors that occur and ensure their quality improvement efforts tackle the most common causes of diagnostic error.

Are some patients more likely than others to be misdiagnosed?

PE: Most misdiagnoses that result in death or permanent disability happen to patients with cancers, infections, or vascular conditions. Cancer misdiagnosis most often occurs in outpatient settings, while misdiagnosis involving infections or acute vascular conditions occur most frequently in emergency departments and inpatient settings. Misdiagnosis also occurs in low prevalence situations, such as a stroke occurring in a young person, or with atypical presentations, such as a stroke presenting with dizziness.

The first step is for clinicians to be aware that a misdiagnosis can occur, especially in these conditions and these contexts. If it’s on their minds, they’re less likely to overlook the possibility. Next, healthcare organizations should prioritize a culture of collaboration. Break down the silos within your walls and make it okay for clinicians to say, “I don’t know, but I think it may be this. What do you think?” Second opinions can help clinicians take offtheir blinders.

What must be done to improve diagnostic accuracy?

PE: We made great strides in the last few years in our understanding of when, where, and why misdiagnoses occur. We need to take this information and shift our focus to strategies and best practices that will improve the diagnostic process. This starts with research. Currently, federal diagnostic quality research funding is surpassed by smallpox research—a condition that was eradicated decades ago. Research funding must increase, and studies should focus on ways to improve the diagnostic process.

Next, we must prioritize the need for quality improvement and unleash the creativity of the field. For our part, over the next three years, SIDM will distribute 20 grants annually, up to $50,000 each, to seed diagnostic quality and safety improvement projects as part of our DxQI Seed Grant Program funded by the Gordon and Betty Moore Foundation. Additionally, the field must join forces to address this problem. SIDM has convened a coalition of more than 50 organizations, including leading hospitals and health systems, to improve diagnostic quality. Visit our website to learn more about it and consider becoming a Coalition member.