Diagnostic Errors is a Threat to Patient Safety

Introduction
Lack of time and sufficient resources have led to diagnostic errors. Cognitive biases of clinicians, underlying problems with healthcare systems, poor teamwork and communication, lack of reliable medical systems have been attributed to missed and delayed diagnoses in the healthcare sector. Doctors formulate ‘working diagnoses’ when patients are admitted to hospitals. Although a diagnosis is uncertain at this point, doctors treat the patient as if the working diagnosis is precise. The working diagnoses are confirmed when a patient improves after a few days of treatment, otherwise the doctors have to consider whether it was wrong (Lambe et al., 2016). However, the time taken to make the right diagnosis through trial and error greatly reduces the patient’s chance of surviving. Little consideration is given to how doctors make diagnoses and refines them to come up with treatment plans for their patients. Physicians require enough time to run correct diagnoses, make the right treatment plans and reviews. Moreover, patients, their families and the society at large haven’t been informed about this impending problem in healthcare practice (AHQR, 2017).
Background and Body
Although many studies on patient safety have cited the prominence of diagnostic errors in the medical field, the practice has received less attention. According to a Harvard Medical Practice Study, errors during diagnosis are responsible for 17% of avoidable errors in patients who have been admitted (Brennan et al., 1991). Moreover, a systematic review of various autopsy research studies conducted over 40 years found that about 9% of patients have undergone a critical error during diagnosis that wasn’t even detected before the demise of the patient. Conclusively, the studies indicate that thousands of patients worldwide die annually as a result of diagnostic errors. A good example, according to a research body, is in the cognitive psychology field where clinicians use heuristics (rule of thumb or shortcuts) to make patient diagnosis based on common symptoms. Although heuristics are important and ubiquitous, various studies have classified the common types of errors clinicians make as a result of using heuristics in patient diagnosis (AHQR, 2017; Sing, 2013).
Evidence-based healthcare is focused on providing ways in which prevailing research evidence can be implemented conscientiously and judiciously in the detection, prevention and treatment of healthcare disorders. However, this aim can only be ambitious due to the slow manner in which new treatments are released into practice and how practitioners are slow to eliminating or withdrawing established treatments that have been in use for better alternatives based on research findings. There are many barriers to implementing research findings on diagnostic errors into practice. Poor access to guidelines and best evidence, research size and complexity, organizational barriers, difficulties in developing evidence-based clinical policy, ineffective continuing education programs, and low patient adherence to treatments have been attributed to poor implementation of evidence-based practice. Lack of resources, time and motivation of clinicians and other stakeholders, including their attitude towards change are other barriers to implementation (Brennan et al.,; AHQR, 2017).
There are many ways to overcome the barriers to implementation of research findings into practice for improved patient safety and general care. Services that abstract information for synthesis should be used to address the problem of research size and complexity. Information systems that integrate patient care with guidelines and evidence can help foster the development of evidence-based clinical policies. Stakeholders in the industry should also develop guidelines to govern how evidence-based clinical guidelines are developed. Improvement of practitioner programs and the quality and effectiveness of education can improve access to guidelines and best evidence from studies. It is also important to develop effective strategies to motivate and encourage patients to follow advice given by medical practitioners (Singh, 2013).
Diagnostic error is a critical threat to patient safety despite the less recognition it has been accorded in the industry. Agency for Healthcare Research and Quality is committed to advancing healthcare quality. AHRQ funds research to help healthcare stakeholders and the society at large to better understand how diagnostic errors occur and what can be done to prevent them. it is a leading Federal organization that invests in research to enhance diagnostics for minimal errors and thus improving patient safety. According to a report it sponsored that was published in 2015 by the Institute of Medicine (IOM), the majority of patients experience a minimum of one diagnostic error in their lifetime. About 10% of patient deaths in healthcare facilities result from diagnostic errors, a major reason for medical liability claims. AHRQ has invested in research since 2007 to avail study findings required to improve existing diagnostic safety information and knowledge and develop practical resources and tools needed to enhance diagnostic safety. The agency offers tools for diagnostic safety improvement, funding for studies on diagnostic errors and other resources related to diagnostic errors (AHQR, 2017).
Conclusion
Many diagnostic errors result due to subtle biases in the thought processes of clinicians. Therefore, systems can be put in place to mitigate the impact of such biases and offer clinicians objective information they need to help with decision-making as part of preventing some diagnostic errors. Regular feedback to clinicians on their performance can help them find out how their diagnosis turned so they are aware of the diagnostic errors they make. There’s need to develop reliable feedback and decision support systems to support clinical diagnosis decisions, especially for difficult or high-risk diagnoses such as sever myocardial infarction. Ongoing studies are investigating how computerized diagnostic decision support can enhance general accuracy of diagnoses (AHQR, 2017).
It is recommended that at least 25% of inpatient deaths should undergo autopsies conducted by teaching institutions. However, only a few teaching hospitals have met this requirement. As a result, clinicians aren’t receiving feedback on their diagnoses and fewer autopsies are being conducted by pathologists during their training. Information technology has enhanced the ability of clinicians to promptly follow up on their diagnostic tests as a way of reducing delayed diagnoses. Communication training and teamwork, telephone triage and enhanced trainee supervision are strategies that can enhance diagnostic performance. However, studies should be conducted to assess the impact of these diagnostic rate interventions (AHQR, 2017; Lambe et al., 2016).
Efforts to aggressively educate clinicians and medical trainees on the critical aspects of cognitive psychology are underway. Clinicians should be engaged in ‘meta-cognition’ so they reflect on their thoughts to be able to know when their heuristics misuse can harm their patients. A systematic review (2016) found that such interventions can enhance the diagnostic reasoning of a clinician in settings that are simulated. Other recent reviews of the same kind have investigated the findings on various strategies to prevent systems problems and cognitive errors during diagnosis. Information systems and healthcare settings must be designed to optimize the ability of clinicians to see, comprehend and reflect on the information required to make precise diagnoses. Clinicians require sufficient time to conduct careful diagnosis, plan treatment and review the same. They must be accorded the time, space and information they need to do their job; they need these resources to engage in critical clinical thinking to make the right diagnosis and treatment plans for their patients (AHQR, 2017).



References
Brennan TA ; Newhouse JP; et al. The nature of adverse events in hospitalized patients. Results of the Harvard Medical Practice Study II. N Engl J Med. 1991; 324: 377-384
Lambe KA ; O'Reilly G ; Kelly BD; et al. Dual-process cognitive interventions to enhance diagnostic reasoning: a systematic review. BMJ Qual Saf. 2016; 25: 808-820
Resources Related to Diagnostic Errors. Content last reviewed December 2017. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/diagnostic-safety/resources.html
Shojania KG ; Burton EC ; McDonald KM; et al. Changes in rates of autopsy-detected diagnostic errors over time: a systematic review. JAMA. 2003; 289: 2849-2856
Singh, H. (2013). Diagnostic errors: moving beyond “no respect” and getting ready for prime time. BMJ Quality & Safety, 22(10), 789–792. http://doi.org/10.1136/bmjqs-2013-002387