A Call to Action: Reducing Diagnostic Error
The patient safety movement has finally recognized the importance of the diagnostic process in patient care. With the release of the recent Institute of Medicine (IOM) report “Improving Diagnosis in Healthcare”, this should be a call to action for all healthcare providers involved in the diagnostic process, in particular, pathologists. Pathologists are important diagnosticians in the process. All treatment begins with a diagnosis.
The IOM report states that diagnostic errors affect at least 1 in 20 U.S. outpatients each year, or 12 million per year. An excellent New England Journal of Medicine article frames the scope and impact.
The IOM lists several important recommendations that are of particular interest to pathologists.
With each goal, I have itemized interventions that pathologists can positively impact.
Goal 1: Facilitate more effective teamwork in the diagnostic process among health care professionals, patients, and their families
Healthcare organizations should foster collaboration among pathologists, radiologists, other diagnosticians, and treating health care professionals to improve the diagnostic testing process.
Pathologists must engage with patients in order to educate them on the diagnostic process.
Goal 2: Enhance health care professional education and training in the diagnostic process
Pathologists must take the lead on utilization initiatives such as:
Appropriate use of diagnostic tests and the application of these results on subsequent decision making
Informatics skills, use of health information technology
Ensuring maintenance of certification
Goal 3: Ensure that health information technologies support patients and health care professionals in the diagnostic process
Clinical decision support tools
Flow of information throughout the care cycle
Goal 4: Develop and deploy approaches to identify, learn from, and reduce diagnostic errors and near misses in clinical practice
The College of American Pathologists (CAP) can help pathologists monitor the diagnostic process and identify, learn from, and reduce diagnostic errors and near misses in a timely fashion.
There is a need for funding for a designated subset of health care systems to conduct routine postmortem examinations on a representative sample of patient deaths.
CAP can help pathologists identify opportunities to improve accurate and timely diagnoses and reduce diagnostic errors in their specialties.
Goal 5: Establish a work system and culture that supports the diagnostic process and improvements in diagnostic performance
Pathologists are key members in error reducing initiatives such as:
Quality management program
Root cause analysis
Communicating clinically significant results
Goal 6: Develop a reporting environment and medical liability system that facilitates improved diagnosis by learning from diagnostic errors and near misses
Participate in reporting of diagnostic errors and near misses
Disclosure and apology process
Goal 7: Design a payment and care delivery environment that supports the diagnostic process
Create current procedural terminology codes and provide coverage for additional evaluation and management activities not currently coded or covered, including time spent by pathologists, radiologists, and other clinicians in advising ordering clinicians on the selection, use, and interpretation of diagnostic testing for specific patients.
Goal 8: Provide dedicated funding for research on the diagnostic process and diagnostic errors
Pathologists are important stakeholders in research on the diagnostic process and diagnostic errors.
Recently, the CAP issued an evidence based guideline on error reduction in pathology. More such efforts, with involvement by all pathologists, are needed.
Situated at the intersection of all medical specialties, pathologists provide the link between the science and practice of medicine. All treatment begins with a diagnosis. Whether it be the results of a common blood test, tissue biopsy or esoteric molecular analysis, pathologists give direction to the work up of patient problems. A pathologist is a key member of the care team. Any attempt at error reduction must involve leveraging the unique skill set of the pathologist. Follow Path Report for continuing updates on the value pathologists help deliver.