5% of Patients Experience Diagnostic Error, Says IOM

An Institute of Medicine report estimates that most people will experience at least one diagnostic error in their lives and that the severity of these errors will "worsen as the delivery of healthcare and the diagnostic process continue to increase in complexity."

Diagnostic errors are a factor in 10% of patient deaths, account for as much as 17% of hospital adverse events, and are a leading driver of medical malpractice claims, according to a sweeping report released Tuesday by the Institute of Medicine.

The report, Improving Diagnosis in Health Care, calls diagnostic errors "a blind spot" in healthcare delivery that has been around for decades which persists across all care settings and harms "an unacceptable number of patients."

The report offered a "conservative estimate" that 5% of U.S. adults who seek outpatient care experience a diagnostic error, and that most people will experience at least one diagnostic error in their lives, "sometimes with devastating consequences."

"Despite the pervasiveness of diagnostic errors and the risk for serious patient harm, diagnostic errors have been largely unappreciated within the quality and patient safety movements in healthcare," the report said. "Without a dedicated focus on improving diagnosis, these errors will likely worsen as the delivery of healthcare and the diagnostic process continue to increase in complexity."

The committee defined 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."

The report blamed diagnostic errors on "a wide variety of causes, including:

• Inadequate collaboration and communication among clinicians, patients, and their families;
• A healthcare work system that is not well designed to support the diagnostic process;
• Limited feedback to clinicians about diagnostic performance;
• A culture that discourages transparency and disclosure of diagnostic errors—impeding attempts to learn from these events and improve diagnosis."

"Improving the diagnostic process is not only possible, but it also represents a moral, professional, and public health imperative," the report said. "Achieving that goal will require a significant reenvisioning of the diagnostic process and a widespread commitment to change among healthcare professionals, healthcare organizations, patients and their families, researchers, and policymakers."

Diagnostic Error 'Underappreciated'
John R. Ball, MD, chair of IOM's Committee on Diagnostic Error in Health Care, which compiled the report, explained why diagnostic error has remained "underappreciated."

"The data on diagnostic error are sparse, few reliable measures exist, and often the error is identified only in retrospect," Ball wrote in a preface to the report. "Yet the best estimates indicate that all of us will likely experience a meaningful diagnostic error in our lifetime.

While acknowledging the pervasiveness of diagnostic errors, Ball warned against calls for mandatory public reporting.

"The committee believed that, given the lack of an agreement on what constitutes a diagnostic error, the paucity of hard data, and the lack of valid measurement approaches, the time was simply not ripe to call for mandatory reporting," Ball said.

"Instead, it is appropriate at this time to leverage the intrinsic motivation of healthcare professionals to improve diagnostic performance and to treat diagnostic error as a key component of quality improvement efforts by healthcare organizations. Better identification, analysis, and implementation of approaches to improve diagnosis and reduce diagnostic error are needed throughout all settings of care."

This latest IOM report comes nearly 16 years after its landmark study To Err Is Human: Building a Safer Health System, which estimated that as many as 98,000 people in the United States die in hospitals each year from preventable medical errors.

Ball said he hopes this follow up study will "highlight the importance of the issue and direct discussion among patients and healthcare professionals and organizations on what should be done about this complex challenge."

Improving Diagnosis in Health Care by HLMedit