6 Factors that Enable Diagnostic Errors

Poor handoffs, lack of feedback, limited support, and a complex diagnostic process contribute to the thousands of misdiagnosis-related hospital deaths each year.

A coalition of more than 40 patient and provider advocacy organizations on Thursday unveiled a two-year initiative to identify and address diagnostic errors in hospitals, which by some estimates kill as many as 80,000 people each year and are the leading cause of malpractice lawsuits.

"Providing an accurate medical diagnosis is complex and involves uncertainty, but it’s obviously essential to effective and timely treatment," said Paul L. Epner, CEO and co-founder of the Society to Improve Diagnosis in Medicine.

"Nearly everyone will receive an inaccurate diagnosis at some point in their life and for some, the consequences will be grave," Epner said. "Major improvement is needed to systematically identify how to improve diagnostic quality and reduce harm to patients."

SIDM's ACT for Better Diagnosis initiative has identified what it says are the six most common obstacles that impede diagnostic accuracy.

1. Incomplete communication during care transitions—When patients are transferred between facilities, physicians or departments, there is potential for important information to slip through the cracks.
    
2. Lack of measures and feedback—No standardized measures exist for providers to understand their performance in the diagnostic process, to guide improvements, or to report errors. Providers rarely get feedback if a diagnosis was incorrect or changed.
    
3. Limited support to help with clinical reasoning—With hundreds of potential explanations for any one particular symptom, clinicians need timely, efficient resources to assist diagnoses.
    
4. Limited time—Patients and providers report feeling rushed by appointment times, which poses risks to gathering a complete history for diagnosis, and allows scant opportunity to discuss further steps in the diagnostic process.
    
5. The diagnostic process is complicated—There is limited information available to patients about the questions to ask, or whom to notify when changes in their condition occur, or what constitutes serious symptoms. It’s also unclear who is responsible for closing the loop on test results and referrals, and how to communicate follow-up.
    
6. Lack of funding for research—The impact of inaccurate or delayed diagnoses on healthcare costs and patient harm has not been clearly articulated, and there is a limited amount of published evidence to identify what improves the diagnostic process.
    

The coalition is identifying tactics to improve the diagnostic process, such as providing online tools that help physicians recognize and avoid diagnostic pitfalls and improve medical education for new practitioners.

The project is backed by a $3.1 million grant from the Gordon and Betty Moore Foundation.