NEJM Perspective Discusses Impact of New Institute of Medicine Report on Patient Safety

BACKGROUND:
With its new report, Improving Diagnosis in Health Care, the Institute of Medicine (IOM) has acknowledged the need to address diagnostic error as a "moral, professional, and public health imperative." This latest report emphasizes that diagnostic errors may be one of the most common and harmful of patient-safety problems. The report also notes that research findings suggest that diagnostic errors affect at least 1 in 20 U.S. adults in outpatient settings each year, or 12 million adults per year. The IOM report defines diagnostic error as "the failure to (a) establish an accurate and timely explanation of the patient's health problem(s), or (b) communicate that explanation to the patient."

SUMMARY:
The authors of the NEJM article discuss why the topic of diagnostic error is timely and suggest next steps to translate the IOM recommendations into action. They note that the IOM report can contribute to a needed overhaul in the U.S. health care system, as it provides concrete recommendations for major systems and process changes to help improve the diagnostic process, thereby reducing errors. These recommendations include: strengthening teamwork, reforming the teaching of diagnosis, ensuring that health information technology (IT) supports the diagnostic process, measuring and learning from errors in real-world practice, promoting a culture of diagnostic safety, reforming the malpractice and reimbursement systems, and increasing research funding. The authors also support the IOM's multi-faceted approach affirming that many underlying factors related to diagnostic error are intricately linked to problems in health care delivery. They note that for the past 15 years, the patient-safety movement has focused mostly on treatment-related harms but many new challenges related to diagnosis have surfaced, including interactions that are too brief to allow clinicians to listen to patients, productivity pressures, and reimbursement systems that don't adequately support clinicians' cognitive work. They note that the new IOM report restores balance to the quest to improve patient-safety by calling attention to diagnosis – the other half of medicine.

NOTE:
This IOM report was prepared by the Committee on Diagnostic Error in Health Care, a group of experts that included Carolyn Clancy, MD, VA's Chief Medical Officer and former interim Under Secretary for Health. The report synthesizes what is known about diagnostic error and proposes recommendations to improve the diagnostic process. NEJM Perspective author Dr. Hardeep Singh, part of HSR&D's Center for Innovations in Quality, Effectiveness and Safety in Houston, TX, testified before the IOM Committee and was an invited expert reviewer for this report. The IOM report also drew heavily upon previous patient safety research by Dr. Singh's Houston-based team, which contributed significantly to the growing momentum for change in this crucial area of health care quality and safety.

Singh H and Graber M. Improving Diagnosis in Health Care – The Next Imperative for Patient Safety. The New England Journal of Medicine (Perspective). December 24, 2015;373(26):2493-95.