IOM sounds alarm on diagnostic errors

Errors likely to worsen as healthcare, diagnostic processes increase in complexity
By Bernie Monegain
05:32 AM
Alarm signal

Most people will experience at least one diagnostic error – an inaccurate or delayed diagnosis – in their lifetime, sometimes with devastating consequences, according to a new report from the Institute of Medicine of the National Academies of Sciences, Engineering and Medicine.

One might think that puts the issue top of mind for physicians. However, the study panel found that efforts to improve diagnosis and reduce diagnostic errors have been limited. 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 healthcare settings, IOM noted.

To improve diagnosis and reduce errors, the committee called for:

  • More effective teamwork among health care professionals, patients and families
  • Enhanced training for healthcare 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.

[See also: Deaths by medical mistakes hit records.]

The report and call to action are 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, Crossing the Quality Chasm: A New Health System for the 21st Century and Preventing Medication Errors.

"These landmark IOM reports reverberated throughout the healthcare 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, in releasing the new report. "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.

"I am confident that Improving Diagnosis in Health Care, like the earlier reports in the IOM series, will have a profound effect not only on the way our healthcare system operates but also on the lives of patients."
Data on 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.

They include:

  • Inadequate collaboration and communication among clinicians, patients, and their families;
  • A healthcare work system ill-designed to support the diagnostic process; limited feedback to clinicians about the accuracy of diagnoses;
  • A culture that discourages transparency and disclosure of diagnostic errors, which impedes attempts to learn and improve. 

Errors will likely worsen as the delivery of healthcare and the diagnostic process 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.

[See also: CPOE cuts medication errors, study shows.]
"Diagnosis is a collective effort that often involves a team of healthcare professionals – from primary care physicians, to nurses, to pathologists and radiologists," said John R. Ball, chair of the committee and executive vice president emeritus, American College of Physicians.

"The stereotype of a single physician contemplating a patient case and discerning a diagnosis is not always accurate, and a diagnostic error is not always due to human error. Therefore, to make the changes necessary to reduce diagnostic errors in our healthcare system, we have to look more broadly at improving the entire process of how a diagnosis made."
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 healthcare 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. 

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

Few healthcare organizations have processes in place to identify diagnostic errors and near misses in clinical practice.  However, collecting this information, learning from these experiences, and implementing changes are critical for achieving progress, the report concludes.