The ECRI Institute (formerly the Emergency Care Research Institute), has announced diagnostic errors as the top concern within its 2018 Top 10 Patient Safety Concerns for Healthcare Organizations report. ECRI Institute is an independent non-profit organization which dedicates itself to applying scientific research to discover which medical processes, devices, procedures and drugs are best and improve patient care. The ECRI Institute serves 5,000 members and clients include hospitals, health systems, public and private payers, U.S. federal and state government agencies, health clinics, patients, policymakers and ministries of health.
ECRI Institute’s 2018 list of patient safety concerns was announced at their Plymouth meeting last week. The list is as follows:
- Diagnostic errors
- Opioid safety across the continuum of care
- Care coordination within a setting
- Incorporating health IT into patient safety programs
- Management of behavioural health needs in acute care settings
- All-hazards emergency preparedness
- Device cleaning, disinfection and sterilization
- Patient engagement and health literacy
- Leadership engagement in patient safety
The list identifies the top concerns which have appeared in the ECRI Institute member’s inquiries, their root cause analyses, and in the adverse events submitted to their Patient Safety Organization (PSO). ECRI Institute PSO has received 2 million event reports and reviewed hundreds of root-cause analyses since 2009.
Reviewing their top concern of diagnostic errors, ECRI Institute stated: ‘Each year approximately 1 in 20 adults experience a diagnostic error, according to published studies. These errors and delays can lead to care gaps, repeat testing, unnecessary procedures and patient harm.’ Gail M. Horvath, MSN, RN, CNOR, CRCST, a patient safety analyst at the ECRI Institute, went on to say: “diagnostic errors are not only common but can have serious consequences. A lot of hospital deaths that were attributed to the normal course of disease may have been the result of diagnostic error.”
The recommendations from the ECRI Institute includes using structured tools and algorithms to overcome cognitive biases that leads to errors. Organizations can capture data when errors or near misses occur, which they can then utilize to learn from the errors. Horvath also mentioned clinical decision support interventions can flag incidental findings that require follow-up, and also identify tests which have not been done.
The Society to Improve Diagnosis in Medicine (SIDM) is driving change through medical education, quality improvement and patient engagement initiatives to improve diagnosis and reduce diagnostic error. Their CEO, Paul Epner, has said of the ECRI press release: “SIDM applauds the ECRI Institute for calling attention to the problem of diagnostic errors and noting that it is both a cognitive and system problem. We join them in calling on healthcare organizations to measure, report and develop initiatives to improve the diagnostic process.”
The Future of Diagnosis
It is well known that diagnostic errors have received little attention in the patient safety field until recently, however, great strides have been made in the past four years. Diagnostic error and patient engagement were previously seen as a physician orientated problem, but over recent years evidence has shown that diagnostic error affects and is a responsibility for all of us, whether we are a physician, nurse, administrator, patient, relative, pharmacist or another member of the health care team. We all work in partnership together, with the patient at the centre of a decision, to reach a correct diagnosis and devise a plan of action to manage their often complex heath needs. With this knowledge and focus on diagnostic error there has been an increase in digital health tools to help both patients and health care providers. They can research symptoms or clinical features, find accurate evidenced based information about conditions, and engage with each other collaboratively to reach a conclusion. Isabel Healthcare actively participates in this team engagement by providing a clinical decision support tool for health professionals, called the Isabel DDx Generator, and the Isabel Symptom Checker for patients.
It is great to see diagnosis error receiving the attention it deserves within the centre of the patient safety movement, and we hope that this will continue following the release of this ECRI report. We've written a white paper on why we think it is so important to focus on diagnosis, and you can download that by selecting button below. We also have a section on our website with some of the most important publications on the subject of diagnostic error.