Study: Diagnostic Errors Are Too Common

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At some point in their lives, most people will get an inaccurate or delayed diagnosis that could have serious consequences, says a new report from the Institute of Medicine of the National Academies of Sciences, Engineering, and Medicine. 

And the findings also revealed that there have been only limited efforts to improve diagnosis and reduce errors. Improving diagnosis is a complex challenge, partly because making a diagnosis is a collaborative and inherently inexact process that may unfold over time and across different health care settings. 

To improve diagnosis and reduce errors, the committee called for more effective teamwork among health care professionals, patients, and families; enhanced training for health care 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.

This report is a continuation of the Institute of Medicine’s Quality Chasm Series, which includes reports such as To Err Is Human: Building a Safer Health System. “These landmark IOM reports reverberated throughout the health care community and were the impetus for system-wide improvements in patient safety and quality care,” said Victor J. Dzau, president of the National Academy of Medicine.

 “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.”

According to a release from the Institute of Medicine, diagnostic errors are sparse, few reliable measures exist, and errors are often found in retrospect, the committee found.  However, 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 health care 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.

And errors will likely worsen as the delivery of health care and the diagnostic process continue to increase in complexity, the committee concluded.  To improve diagnosis, a significant re-envisioning of the diagnostic process and a widespread commitment to change from a variety of stakeholders will be required.

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 that health care 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, health care organizations and professionals should create environments in which patients and families are comfortable sharing feedback and concerns about possible diagnostic errors.

Additionally, according to the news release, the committee recommended that health care professional education and training emphasize clinical reasoning, teamwork, communication, and diagnostic testing.  The committee also urged better alignment of health information technology with the diagnostic process.  Furthermore, federal agencies should develop a coordinated research agenda on the diagnostic process and diagnostic errors by the end of 2016.