A framework of strategies has been developed around five dimensions of inpatient diagnostic errors. Researchers say their work is also applicable to other patient populations.
Researchers at Baylor College of Medicine have developed a framework of strategies to reduce diagnosis errors in hospitalized patients.
While investigating diagnosis errors in hospitalized patients, the researchers identified five dimensions of diagnosis, then analyzed errors to identify improvement opportunities within each dimension. Their work was published in Annals of Internal Medicine.
National patient safety initiatives and CMS's efforts to reduce hospital-acquired conditions and readmissions have not focused on misdiagnoses, noted study co-author Hardeep Singh, MD, MPH, associate professor of medicine at Baylor and chief of the Health Policy, Quality and Informatics Program at the Houston VA Center for Innovations in Quality, Effectiveness and Safety.
The research focused on inpatients, but the dimensions of diagnosis and corresponding improvement opportunities are broadly applicable, Singh said in a statement.
The five dimensions and some suggested improvements include:
- Patient-physician encounter: Allocate time to effectively communicate with patients; seek "cognitive support" to assist decision-making in cases of uncertainty
- Performance and interpretation of diagnostic tests: Collaborate in person with lab professionals and radiologists to interpret complex test results or in cases of difficult diagnosis
- Follow-up and tracking of diagnostic information over time: Do not overlook past diagnostic data during the current hospitalization; clarify responsibilities of follow-up of abnormal test results
- Subspecialty consultation-related communication and coordination: Use direct verbal communication when making critical decisions; ensure everyone on the team is on same page about the diagnosis when multiple consultants are involved
- Patient-focused strategies: Encourage proactive patient and family participation in the diagnostic process; encourage patients to look at their own medical notes to find inconsistencies
The authors also noted "conceptual challenges" surrounding diagnosis errors. For example, it can be difficult to identify whether an error has occurred and the way people think about diagnoses and errors can change over time.
"The term 'error' should be used only when unequivocal evidence suggests that a key finding was missed or not investigated when it should have been," the researchers wrote. "Errors should also be framed as learning and improvement opportunities, not moments for assigning blame."
Thinking of errors as missed opportunities gives clinicians the chance to identify what could have been done differently in the diagnostic process and how to apply this knowledge to improve safety, the researchers concluded.