The Leapfrog Group on Thursday released a set of 29 recommendations to help hospitals decrease diagnostic errors and "prevent harm to the patient."
How common are diagnostic errors?
According to Leapfrog, a diagnostic error is a delayed, inaccurate, or missed diagnosis, or a correct diagnosis that is not properly communicated to a patient and their family members.
"When we talk about diagnostic error, we do not mean cognitive mistakes made by one prescriber or one clinician, because everybody makes mistakes," said Leah Binder, Leapfrog president and CEO.
Each year, roughly 250,000 hospital patients experience diagnostic errors in the United States, which contribute to over 40,000 deaths in adult ICUs, Modern Healthcare reports. In addition, diagnostic errors make up one-third of severe harm malpractice claims nationwide.
According to the Society to Improve Diagnosis in Medicine, almost 75% of diagnostic errors in the United States are attributed to cancer, cardiovascular events, and infection.
To help hospitals improve patient safety and prevent diagnostic errors, Leapfrog released a report with 29 evidence-based recommendations from the nation's top experts on diagnostic excellence, including physicians, nurses, patients, health plans, and employers.
"We are addressing what can be done to prevent harm to the patient as a result of a diagnostic error. Does the health system have in place the systems and the leadership that they should?" Binder said.
"Many think that this problem is so overwhelming that they might just throw up their hands and give up," Binder said. "The goal of this report is to give hospitals a place to start."
"Clinicians and hospital leaders tell us they know diagnostic errors are harming too many patients, but they are less clear on how to fix the problem," Binder added. "Thanks to the incredible leadership of the multi-stakeholder group Leapfrog has convened, hospitals now have clarity on the steps to take. The faster hospitals act, the more lives they can save."
Leapfrog's recommendations for diagnostic excellence
For the report, Leapfrog conducted a literature review to identify over 300 potential practices to address diagnostic errors. Leapfrog's Advisory Group then met to select the 29 practices that most aligned with the following guiding principles:
- Strength of evidence behind the practice
- How well the practice relates to organizational leadership, structures, or systems
- Whether the practice has been successfully implemented in health care systems
The recommendations were divided into two domains—organizational leadership and systems, and the diagnostic process.
The group's recommendations for organizational leadership and systems include 16 recommended practices under five subdomains:
Senior leaders must be held accountable for diagnostic safety and quality.
- Set goals for patient engagement, communication, and teamwork.
- Form a multidisciplinary team to promote diagnostic safety and quality.
- Communicate progress of diagnostic safety programs.
A hospital's culture should support diagnostic safety, quality, and transparency.
- Show a commitment to diagnostic excellence through CEO leadership.
- Encourage teamwork.
- Provide targeted training and education to nurses, pharmacists, and allied health professionals.
- Make it simple for hospital staff to report any diagnostic errors or concerns.
- Openly discuss diagnostic errors with patients.
Implement processes and structures to engage patients in their care.
- Help patients and their caregivers communicate complete and accurate information.
- Make it easy for patients and family caregivers to report diagnostic errors and concerns.
- Empower patients and family caregivers to escalate care.
Implement processes and structures to identify risks and hazards in the diagnostic process.
- Conduct a risk assessment.
- Measure and monitor diagnostic safety outcomes.
- Optimize the EHR to support accurate and timely diagnosis.
Ensure that financial, technological, and staffing resources are allocated to support learning and improvement initiatives.
- Allocate time for analysis and learning.
The group's recommendations for the diagnostic process include 13 recommended practices under three subdomains:
Implement processes and structures to gather accurate and complete information from patients and other sources.
- Train clinicians and others involved in the diagnostic process to gather accurate health information.
- Correct inaccurate diagnosis and data in the EHR.
- Ensure medical interpreters are available.
Implement processes and structures to enable correct interpretation and synthesis of information.
- Ensure access to radiology experts.
- Conduct joint reviews of diagnostic discrepancies.
- Provide necessary diagnostic expertise for patients who are admitted to the ED.
- Provide knowledge resources to clinicians.
- Provide training to help clinicians recognize and minimize cognitive errors.
- Implement and monitor compliance with diagnostic guidelines.
Implement processes and structures to effectively communicate diagnostic information to patients and ensure timely and complete handoffs during care transitions.
- Encourage patients to use patient portals.
- Address diagnostic uncertainty at handoffs.
- Clearly communicate instructions to patients discharged with an uncertain diagnosis.
- Clearly communicate instructions to patients discharged with pending test results.
- Implement "closed loop" communications.
(Devereaux, Modern Healthcare, 7/28; Leapfrog news release, 7/28; Leapfrog, "Recognizing Excellence in Diagnosis: Recommended Practice for Hospitals," 7/28)