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5 Ways to Reduce Costly Diagnostic Errors

 |  By Sandra Gittlen  
   June 05, 2017

Healthcare providers are working to improve diagnostic accuracy. Here are five tips from four experts.

This is an excerpt of an article that first appeared in the October 2016 issue of HealthLeaders magazine.

Diagnostic errors, no matter their origin, are costly.

The National Academies of Sciences, Engineering, and Medicine—Health and Medicine Division found that 5% of U.S. adults who seek outpatient care each year experience a diagnostic error.

Diagnosis-related payments, Johns Hopkins researchers found, amounted to $38.8 billion between 1986 and 2010.

But there are things physicians and care teams can do to improve diagnostic accuracy.

1. Expand Your View

Through his work in ambulatory care clinics, Mikael Jones, PharmD, BCPS, clinical associate professor at the University of Kentucky College of Pharmacy, says he has realized that an efficient way to decrease diagnostic error rates is to form cohesive care teams.

He points to the case of an elderly patient he consulted on five years ago. The woman presented to the clinic with severe diarrhea and generally wasn't feeling well. Her history showed a recent course of antibiotics, and the nurse practitioner was worried about Clostridium difficile colitis or C. diff, which would be catastrophic in a patient her age.

Before concluding that diagnosis, Jones asked about other medications she was taking. The woman had been consuming a dietary herbal supplement, which Jones found to have a high likelihood of causing diarrhea.

"I suggested taking a step back and seeing if stopping the supplement would make a difference, and it did," he says. Ultimately, the woman did not have to undergo taxing C. diff treatment.

Jones learned from that experience to make the diagnostic process a team sport and to be more specific in patient questioning. "Don't just ask about medications; ask them about prescription, non-prescription, and supplements," he says.

2. Follow the Data

Information flow has to improve, too, he says. For instance, while e-prescribing has made it easier to get prescriptions to pharmacies, the information flow back to the prescriber about whether a patient has filled the prescription is lacking.

Knowing how soon the prescription was picked up also is important because some medications, to be effective, have to be taken in a certain time frame.

He also believes provider notes should be looked at as a way to reduce diagnostic errors. "The notes are getting longer and longer and a lot of information is being imported. One incorrect fact can be easily propagated," he says.

"I make sure to look at all medication notes and reconcile them with what the patient is saying and what was intended by the healthcare provider."

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