Pushing hospitals to reduce diagnostic errors

Some adverse events harming patients in hospitals can be traded to mistakes in the diagnosis, analysts say.

Hospitals need to focus on reducing diagnostic errors, says Leah Binder, president and CEO of The Leapfrog Group.

The National Academies issued a landmark report in 2015 highlighting the dangers of diagnostic errors, an area which hasn’t always received great attention. The report suggested that diagnostic errors contribute to 10% of patient deaths.

The Leapfrog Group, a nonprofit organization advocating for patient safety, is looking to bring greater attention to diagnostic errors. The group released a new report Tuesday that’s intended to spur changes in hospitals, and it’s a sequel to an earlier report on diagnostic problems published in 2022.

Leah Binder, president and CEO of The Leapfrog Group, said hospitals must rethink the way they diagnose patients.

“Instead of thinking of diagnosis as a one-directional, individualistic enterprise where one clinician makes a diagnosis, it is then translated for one patient, it's actually really about one patient and one patient's experience, and how all of a range of caregivers and the patient themselves and their family collaborate together to make sure that's the right diagnosis,” Binder said in a webinar Tuesday.

“And if it's not, go to plan B and have new diagnoses and new ways of treating and caregiving,” she added. “It's really an iterative ongoing process, and it requires the entire team.”

• Read more: Leapfrog Group Spring 2024 Hospital Safety Grades: Infections drop, but there’s room to improve

A greater commitment

Jean-Luc Tilly, program manager of healthcare ratings at the Leapfrog Group, said diagnostic errors have different components. They can include incorrect or delayed diagnoses, but they also can involve miscommunication with the patient.

“The diagnosis was made, it was available, but it wasn't … effectively communicated to the patient or the family,” Tilly said during the webinar.

Tilly also suggests that hospitals could be looking more comprehensively at ways of reducing diagnostic errors.

“A lot of hospitals are doing some kind of discrete, one-off initiatives and have a good patient safety program, but they haven't really committed to diagnostic excellence,” Tilly said.

The report outlines 22 recommendations for hospitals to reduce diagnostic errors. Here are some of the recommendations:

• Openly communicating diagnostic errors to patients;
• Making it easy for hospital staff to report errors and concerns;
• Giving clinicians resources they need to stay up-to-date with the latest research and support decision making;
• Measure diagnostic safety outcomes;
• Create a multidisciplinary team on diagnostic safety and quality;
• Optimize electronic health records to support accurate diagnosis;
• Conduct a risk assessment.

‘Diagnostic mis-management’

The Leapfrog Group surveyed 95 hospitals to examine how many were implementing best practices to avoid diagnostic errors. Tilly acknowledged that many of the hospitals are higher performing hospitals when it comes to patient safety, and many had incorporated recommendations to improve diagnostic accuracy. He said he suspected adoption rates of best practices would likely be lower nationwide.

The survey found all respondents have medical interpreters available, and the vast majority (92%) said they communicated diagnostic errors to patients, while 89% said they make it easy for staff to report diagnostic errors.

• Read more: In a first, Leapfrog Group's hospital safety grades rank the top metro areas

Even among the higher-performing hospitals that responded to this survey, some practices were less widely adopted. The report found that 75% of hospitals devote time to analysis and learning, while about two-thirds (69%) said they communicate clear instructions to patients with uncertain diagnosis.

Hospitals that are going to make gains in improving diagnostic accuracy need to have the commitment of top executives. Tilly said that’s not “systematically implemented.”

He also pointed to the need for more hospitals to form multidisciplinary teams to look at reducing diagnostic errors.

“It’s so hard to meaningfully affect hospital-wide change without a core focus group,” Tilly said.

Hospitals should also engage, or revive, advisory councils of patients, families and caregivers, Tilly says. Some hospitals have let those councils lapse since the COVID-19 pandemic, but those panels can offer important insights for providers, he says.

Health systems looking to do better should also consider using the Agency for Healthcare Research and Quality’s “Measure Dx” guide to help hospitals reduce diagnostic errors. The federal agency offers another tool, Calibrate Dx, aimed at helping doctors improve their diagnostic skills.

The Leapfrog Group is going to be surveying more hospitals to gauge practices they are using to reduce diagnostic errors, and eventually hopes to engage in scoring those efforts and releasing them to the public.

Binder says the problem goes beyond individual errors and is better described as “diagnostic mis-management.” She says hospitals need to do better.

She also says it’s going to be a growing focus of the Leapfrog Group. Even though the organization has focused on patient safety with its hospital safety grades, Binder says the group saw a need to focus on problems in diagnosing conditions.

“There was this other aspect of safety that we knew very little about that was emerging in the literature, diagnostic errors, and we got very, very involved and interested in what we could do,” she says.

“We consider this an extremely high priority,” Binder says.