Healthcare organizations have focused on improving patient outcomes for years. Lately, however, the impact of diagnostic errors on outcomes has come under more intense scrutiny. Some research suggests that nearly 800,000 Americans die or are permanently disabled each year due to misdiagnosis.
One reason the impact of diagnostic errors is often underappreciated is because of a lack of data. Simply put: Diagnostic errors aren’t always clearly identifiable. They’re not like surgical errors or patient falls that are easily recognized and reported. Instead, diagnostic errors tend to happen across a continuum of healthcare team members and caregivers. Often, there is no feedback to know when an error has occurred, let alone how it occurred.
In reality, diagnosis is truly a “team sport.” It’s a journey — a process that involves many different facets. In 2015, a report titled Improving Diagnosis in Healthcare highlighted the critical nature of diagnostic errors and provided a specific pathway to diagnostic excellence. This research remains crucial today as we continue to drive improvements in healthcare by addressing the complexities of the diagnosis process, and the key is understanding what we can do to strengthen the diagnostic team.
How (and Where) to Find the Best Value Rehabilitation Programs for Brain Injuries
Choosing the right brain injury rehabilitation program is a critical decision that can shape the future for you or your loved one.
First step: Identify your vulnerabilities
The first step toward reducing diagnostic errors is admitting that the diagnostic process sometimes fails, and we don’t always know which players on the team can help prevent that failure. However, we can examine and address vulnerabilities in the diagnostic process.
To mitigate risk from diagnostic errors, healthcare organizations should leverage data to pinpoint their diagnostic process’s unique vulnerabilities. They can start by analyzing both their own data and industry-wide data.
For example, it’s important to understand where in your system the diagnostic errors occur. For many health systems, diagnostic errors are the most common cause of malpractice claims in ambulatory settings — especially with regard to cancer-related diagnoses. Furthermore, while cancer-related misdiagnosis events may be most common in the office setting, instances of alleged infection and stroke errors rise to the top in the ED.
Price Transparency is the New North in the PBM World
In this episode hear how improving benefit verification, prior authorizations, and patient affordability with smart integrations and real-time eligibility can streamline healthcare workflows.
Some other data sources that could help organizations uncover the weaknesses within their distinctive diagnostic process include adverse event data, patient complaint data, medical malpractice claims analysis, quality metrics, and peer reviews. Organizations can also learn from many publicly available case studies about failed diagnoses.
Second step: Empower your team
The second step to lessen diagnostic errors is to ensure that all players in the diagnostic process recognize their roles. That means embracing the concept of a diagnostic team and educating providers and care teams about their contribution to it.
Providers receive data and intelligence from multiple sources to inform a diagnosis. These may include lab tests, radiology studies, consultations, and a wide range of primary care clinicians, specialty clinicians, physical therapists, office staff, call center staff, etc.—some of whom are often overlooked. All these individuals have an opportunity to share relevant information. Just as importantly, they should be accountable for detecting missing data and vulnerabilities in the diagnostic process, and bringing them to the team’s attention.
The truth is that so many individuals and systems supply diagnostic data and intelligence that making a diagnosis generally does not fall on one individual. Recently, the Agency for Healthcare Research and Quality (AHRQ) even launched a diagnosis improvement course as a part of its TeamSTEPPS® program that supports the concept of diagnosis as a team sport.
Third step: Implement solutions
Once healthcare organizations identify their diagnostic exposures and educate their diagnostic teams, the final step is to combine those activities into actionable process improvement. While every organization will have its own challenges to address, some typical areas of opportunity include patient engagement, communication, and documentation.
- Patient engagement
Patient engagement may not immediately come to mind as a way to enhance the diagnostic process. Yet, patients are crucial members of the diagnostic team. Patients not sufficiently engaged in their care may fail to follow through on the appropriate diagnostic tests or specialty referrals, which can cause significant diagnosis delays. Therefore, organizations may be able to mitigate the risk of delayed or missed diagnoses by:
- facilitating a focused conversation with the patient and family to elicit a full history of the issue, problem or concern, and a clear understanding of the patient’s symptoms.
- helping patients understand why they need to adhere to the next steps recommended by their providers.
- putting systems in place to track and manage patient follow-ups.
Organizations should encourage patients to actively engage in their care by talking with their providers, as well as by leveraging portals to review test results and other details. In addition to better outcomes, one non-clinical benefit of fostering ongoing patient communication and transparency is that engaged patients who trust and like their providers may be less likely to file a malpractice claim in the event of a delayed or missed diagnosis.
- Communication
Likewise, data suggest that information-gathering and information-sharing processes across and within the care team can be key drivers of diagnostic errors—making communication a fundamental area of focus.
Too often, we find that healthcare fragmentation leads to situations where vital information is available but is missed or incomplete. This is especially prevalent in ambulatory settings. Examples include when:
- front desk staff fail to communicate essential information to providers.
- primary care providers refer patients to specialists without giving the specialists enough information to fully fathom why.
Numerous pressures — staffing shortages, burnout, and increased patient volumes, to name a few — make communication difficult. Still, healthcare organizations can mitigate risk by establishing clear communication policies and procedures, and regularly assessing them to ensure they are followed.
For example, organizations can urge providers to send notes to specialists explaining why a patient’s consultation is necessary before the patient arrives. They can also use standardized communication tools, such as SBAR (Situation, Background, Assessment, Recommendation), to promote clearer and more consistent communication among providers.
- Documentation
Documentation is one aspect of communication, but it’s critical because it supports both clinical decision-making and continuity of care. Moreover, as a legal record, good documentation can often protect providers in the event of a malpractice claim.
Organizations can mitigate risk by encouraging providers to document their thought processes thoroughly. Providers should clearly capture the patient’s history and the care provided, as well as the rationale behind clinical decisions. That means documenting not only what was done and why, but also what wasn’t done and why not. This kind of transparency can help establish that appropriate care was given, and thus help defend against allegations of negligence.
Stronger team, fewer errors, better outcomes
Reducing diagnostic error is a significant part of healthcare organizations’ efforts to improve patient outcomes. By using data to recognize vulnerabilities in the diagnostic process, organizations can proactively correct the potential root causes of diagnostic errors and thus enhance outcomes.
But data alone is not enough. Organizations must also empower their diagnostic teams and foster an environment where every team player understands their vital role in the diagnostic process. While data is needed to identify vulnerabilities, teamwork is required to resolve them.
Dana Siegal RN, CPHRM, CPPS, is the Vice President of Risk Management and Analytics at Coverys, an innovative provider of medical malpractice insurance dedicated to helping policyholders anticipate, identify, and manage risks to reduce errors and improve outcomes. During her extensive career, Siegal, a registered nurse, has served as Director of Patient Safety at CRICO Candello and on the Board of Directors for the Society to Improve Diagnostic Medicine (SIDM).
This post appears through the MedCity Influencers program. Anyone can publish their perspective on business and innovation in healthcare on MedCity News through MedCity Influencers. Click here to find out how.