A coalition of over 40 healthcare and patient advocacy organisations have come together to improve the quality of medical diagnoses. Researchers estimate that up to 80,000 deaths a year in US hospitals can be attributed to inaccurate or delayed diagnoses.
ACT for Better Diagnosis, an initiative of the Society to Improve Diagnosis in Medicine (SIDM), aims to improve the diagnostic process by calling on organisations to identify and spread practical steps to better ensure diagnoses are Accurate, Communicated and Timely.
Coalition members include:
- ABIM Foundation
- American Society for Health Care Risk Management
- Medical Professional Liability Association
- Association of American Medical Colleges
- American Academy of Family Physicians
- Association of Clinical Scientists
- Midwest Alliance for Patient Safety
- American Academy of Paediatrics
- Children’s Hospital of Philadelphia
- National Association of EMS Physicians
And many more.
“Providing an accurate medical diagnosis is complex and involves uncertainty, but it’s obviously essential to effective and timely treatment,” said Paul L. Epner, Chief Executive Officer and co-founder of SIDM.
“Nearly everyone will receive an inaccurate diagnosis at some point in their life and for some, the consequences will be grave. Major improvement is needed to systematically identify how to improve diagnostic quality and reduce harm to patients.”
Each year, diagnostic errors affect 12mn adults in outpatient settings and are the most common cause of medical errors reported by patients.
Working in collaboration over several months, members of the SIDM-led Coalition to Improve Diagnosis, made up of premier national healthcare and patient advocacy organisations, identified initial obstacles they believe impede diagnostic accuracy, including:
- 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.
- Lack of measures and feedback—Unlike many other patient safety issues, there are no standardised measures for hospitals, health systems, or physicians to understand their performance in the diagnostic process, to guide improvement efforts or to report diagnostic errors. Providers rarely get feedback if a diagnosis was incorrect or changed.
- Limited support to help with clinical reasoning—With hundreds of potential explanations for any one particular symptom, clinicians need timely, efficient access to tools and resources to assist in making diagnoses.
- Limited time—Patients and their care providers overwhelmingly report feeling rushed by limited appointment times, which poses real risks to gathering a complete history that is essential to formulating a working diagnosis and allows scant opportunity to thoroughly discuss any further steps in the diagnostic process and set appropriate expectations.
- 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.
- 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 organisations behind the effort—representing clinicians, patients, health systems, researchers and testing professionals—acknowledge that improvement will require sustained work over several years with all stakeholders engaged.
“The diagnosis process—thinking through a patient’s clinical presentation—is a defining task for our profession, and for internal medicine specialists and subspecialists in particular,” said Dr Ana María López, President, American College of Physicians.
“Critically assessing diagnostic decision-making reveals knowledge gaps, communication pitfalls, and risk for errors.”
Also participating in the coalition are federal liaisons, including the Agency for Healthcare Research and Quality, Centers for Disease Control and Prevention, Centers for Medicare & Medicaid Services and Veterans Health Administration.