Operational measurement of diagnostic safety: state of the science

Abstract

Reducing the incidence of diagnostic errors is increasingly a priority for government, professional, and philanthropic organizations. Several obstacles to measurement of diagnostic safety have hampered progress toward this goal. Although a coordinated national strategy to measure diagnostic safety remains an aspirational goal, recent research has yielded practical guidance for healthcare organizations to start using measurement to enhance diagnostic safety. This paper, concurrently published as an Issue Brief by the Agency for Healthcare Research and Quality, issues a “call to action” for healthcare organizations to begin measurement efforts using data sources currently available to them. Our aims are to outline the state of the science and provide practical recommendations for organizations to start identifying and learning from diagnostic errors. Whether by strategically leveraging current resources or building additional capacity for data gathering, nearly all organizations can begin their journeys to measure and reduce preventable diagnostic harm.

Prolonged Diagnostic Intervals as Marker of Missed Diagnostic Opportunities in Bladder and Kidney Cancer Patients with Alarm Features: A Longitudinal Linked Data Study

“…To our knowledge this is the first study to use a large representative cohort to study how often bladder and kidney cancer patients warranting a fast-track referral are diagnosed in a non-timely fashion, as a marker of clinician guidelines adherence in patients who qualify for guideline recommended specialist diagnostic assessment. Despite challenges with identifying signals of missed diagnostic opportunities using large electronic health records [ 23 ], we were able to develop clinically adjudicated scenarios that captured the recurrence and unexplained nature of clinical features. Our findings highlight the patient groups who were most at risk of having a non-timely GP referral, so that we can better understand how and why non-timely diagnosis of bladder and kidney cancer might occur.…”

“…Although our findings highlighted inequalities in cancer patients who were at risk of having a non-timely referral, it is possible that missed diagnostic opportunities due to a missed or non-timely referral could also occur in patients subsequently diagnosed with disease other than cancer. Further population-based research to determine which symptomatic patients are at risk of having a non-timely referral, complemented by in-depth record review and/or qualitative studies to explore how and why they occur, are paramount [ 23 ].…”

Reducing the Risk of Diagnostic Error in the COVID‐19 Era

“…17 Organizations must also be able to identify these errors to help understand root causes and prioritize interventions. 18 For example, streamlined reporting systems that use apps and hotlines could be developed quickly to ensure that clinicians and patients/families can easily report these errors. Electronic triggers can help detect specific situations indicative of error or delay (eg, patient not on precautions gets switched to precautions during a hospitalization; absence of follow-up on abnormal tests).…”

Bringing the clinical laboratory into the strategy to advance diagnostic excellence

“…AHRQ recognized the absence of a coordinated US strategy to measure diagnostic safety and focused their comments on implementing measurement strategies at the level of the healthcare organization. Building upon this report, an opportunity emerges to develop regional and national strategies for diagnostic surveillance that supports data collection across healthcare organizations that in turn can inform studies and quality improvement initiatives to advance diagnostic excellence [ 68 ]. A system for diagnostic surveillance can build on existing efforts designed to collect and analyze data on medical errors, such as the ECRI work described earlier.…”