Tracking Progress in Improving Diagnosis: A Framework for Defining Undesirable Diagnostic Events

Abstract

Diagnostic error is a prevalent, harmful, and costly phenomenon. Multiple national health care and governmental organizations have recently identified the need to improve diagnostic safety as a high priority. A major barrier, however, is the lack of standardized, reliable methods for measuring diagnostic safety. Given the absence of reliable and valid measures for diagnostic errors, we need methods to help establish some type of baseline diagnostic performance across health systems, as well as to enable researchers and health systems to determine the impact of interventions for improving the diagnostic process. Multiple approaches have been suggested but none widely adopted. We propose a new framework for identifying "undesirable diagnostic events" (UDEs) that health systems, professional organizations, and researchers could further define and develop to enable standardized measurement and reporting related to diagnostic safety. We propose an outline for UDEs that identifies both conditions prone to diagnostic error and the contexts of care in which these errors are likely to occur. Refinement and adoption of this framework across health systems can facilitate standardized measurement and reporting of diagnostic safety.

Regret among primary care physicians: a survey of diagnostic decisions

“…We would therefore suggest that GPs need more support in dealing with regret than is currently provided. As described in our survey, we need analytical procedures to reflect on cases resulting in undesirable outcomes [19,36]. It is particularly important to be able to distinguish between 'true' diagnostic errors, when harm could have been prevented, and other forms of error.…”

Diagnostic Discordance, Health Information Exchange, and Inter-Hospital Transfer Outcomes: a Population Study

“…We find that accounting for changes in documented diagnoses improved the ability to predict inpatient mortality and resource utilization. The ability to know when a diagnosis was identified relative to presentation would be immensely useful for risk and quality measures reflecting diagnostic safety 29 ; timestamped diagnosis codes would be potentially a worthwhile step in that direction.…”

Application of electronic trigger tools to identify targets for improving diagnostic safety

“…The choice of which diagnostic error to focus on could be guided by high-risk areas identified in prior research and/or local priorities 44. Because of challenges to define error, we recommend risk areas where clear evidence exists of a missed opportunity to make a correct or timely diagnosis1 45–48 since this emphasises preventability (focusing efforts where improvement is more feasible) and accounts for the evolution of diagnosis over time.…”