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Are health care provider organizations ready to tackle diagnostic error? A survey of Leapfrog-participating hospitals

  • David E. Newman-Toker EMAIL logo , J. Matthew Austin , Jordan Derk , Melissa Danforth and Mark L. Graber
From the journal Diagnosis

Abstract

Background:

A 2015 National Academy of Medicine report on improving diagnosis in health care made recommendations for direct action by hospitals and health systems. Little is known about how health care provider organizations are addressing diagnostic safety/quality.

Methods:

This study is an anonymous online survey of safety professionals from US hospitals and health systems in July–August 2016. The survey was sent to those attending a Leapfrog Group webinar on misdiagnosis (n=188). The instrument was focused on knowledge, attitudes, and capability to address diagnostic errors at the institutional level.

Results:

Overall, 61 (32%) responded, including community hospitals (42%), integrated health networks (25%), and academic centers (21%). Awareness was high, but commitment and capability were low (31% of leaders understand the problem; 28% have sufficient safety resources; and 25% have made diagnosis a top institutional safety priority). Ongoing efforts to improve diagnostic safety were sparse and mostly included root cause analysis and peer review feedback around diagnostic errors. The top three barriers to addressing diagnostic error were lack of awareness of the problem, lack of measures of diagnostic accuracy and error, and lack of feedback on diagnostic performance. The top two tools viewed as critically important for locally tackling the problem were routine feedback on diagnostic performance and culture change to emphasize diagnostic safety.

Conclusions:

Although hospitals and health systems appear to be aware of diagnostic errors as a major safety imperative, most organizations (even those that appear to be making a strong commitment to patient safety) are not yet doing much to improve diagnosis. Going forward, efforts to activate health care organizations will be essential to improving diagnostic safety.


Corresponding author: David E. Newman-Toker, MD, PhD, Professor of Neurology, Ophthalmology, Otolaryngology and Emergency Medicine; Director, Division of Neuro-Visual and Vestibular Disorders; and Director, Armstrong Institute Center for Diagnostic Excellence, The Johns Hopkins University School of Medicine, Johns Hopkins Hospital, CRB-II, 2M-03, 1550 Orleans Street, Baltimore, MD 21231, USA, Phone: +443-287-9593, Mobile: +443-801-1203, Fax: +410-502-7869

Acknowledgments

Dr. Newman-Toker’s effort was supported by the Armstrong Institute Center for Diagnostic Excellence at Johns Hopkins University School of Medicine. Dr. Austin’s effort was partly supported through a contract with The Leapfrog Group around performance measurement in health care.

  1. Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

  2. Research funding: None declared.

  3. Employment or leadership: None declared.

  4. Honorarium: None declared.

  5. Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

References

1. Institute of Medicine. Improving diagnosis in health care. Washington, DC: National Academies Press, 2015.Search in Google Scholar

2. Graber M, Wachter R, Cassel C. Bringing diagnosis into the quality and safety equations. J Am Med Assoc 2012;308:1211–2.10.1001/2012.jama.11913Search in Google Scholar

3. Graber M, Trowbridge R, Myers J, Umscheid C, Strull W, Kanter M. The next organizational challenge: finding and addressing diagnostic error. Jt Comm J Qual Patient Saf 2014;40:102–10.10.1016/S1553-7250(14)40013-8Search in Google Scholar

4. Singh H, Graber M. Improving diagnosis in health care – The next imperative for patient safety. N Engl J Med 2015;373:2493–5.10.1056/NEJMp1512241Search in Google Scholar

5. Newman-Toker D, Pronovost PJ. Diagnostic errors – the next frontier for patient safety. J Am Med Assoc 2009;301:1060–2.10.1001/jama.2009.249Search in Google Scholar

6. Graber ML, Franklin N, Gordon R. Diagnostic error in internal medicine. Arch Intern Med 2005;165:1493–9.10.1001/archinte.165.13.1493Search in Google Scholar

7. Sarkar U, Bonacum D, Strull W, Spitzmueller C, Jin N, Lopez A, et al. Challenges of making a diagnosis in the outpatient setting: a multi-site survey of primary care physicians. BMJ Qual Saf 2012;21:641–8.10.1136/bmjqs-2011-000541Search in Google Scholar

8. Sarkar U, Simchowitz B, Bonacum D, Strull W, Lopez A, Rotteau L, et al. A qualitative analysis of physician perspectives on missed and delayed outpatient diagnosis: the focus on system-related factors. Jt Comm J Qual Patient Saf 2014;40:461–70.10.1016/S1553-7250(14)40059-XSearch in Google Scholar

9. Trowbridge R, Salvador D, Roy M, Botler J. A restructured root cause analysis process for diagnostic error. Abstract – 4th International Diagnostic Error in Medicine Conference, Chicago, IL, 2011.Search in Google Scholar

10. Croskerry P. The cognitive autopsy. Patient safety in emergency medicine. Lippincott Williams and Wilkins, 2009:302–7.Search in Google Scholar

11. National Patient Safety Foundation. RCA2: Improving root cause analyses and actions to prevent harm, 2016. Available at: http://wwwnpsforg/?page=RCA2.Search in Google Scholar

12. National Patient Safety Foundation at the AMA. Public opinion of patient safety issues: research findings, 1997. Available at: https://www.npsf.org/resource/.../Public_Opinion_of_Patient_Safety_Issues.pdf.Search in Google Scholar

13. VHA Inc. Consumer demand for clinical quality; the giant awakens. Vol 3, 2000. Referenced at: www.ncbi.nlm.nih.gov/pubmed/11330225.Search in Google Scholar

14. Kaiser Family Foundation. National survey on national survey on consumers’ experiences with patient safety and quality information, 2004. Available at: http://kff.org/health-costs/poll-finding/national-survey-on-consumers-experiences-with-patient/.Search in Google Scholar

15. Haskell H. Survey of victims of medical harm. Available at: wwwadvocatedirectoryorg.Search in Google Scholar

16. Southwick F, Cranley M, Hallisy J. A patient-initiated voluntary online survey of adverse medical events: the perspective of 696 injured patients and families. BMJ Qual Saf 2015;24:620–9.10.1136/bmjqs-2015-003980Search in Google Scholar PubMed PubMed Central

17. Harvard School of Public Health. The public’s views on medical error in Massachusetts, 2014. Available at: https://cdn1.sph.harvard.edu/wp-content/.../MA-Patient-Safety-Report-HORP.pdf.Search in Google Scholar

18. Isabel Medical Charity. Misdiagnosis is an overlooked and growing patient safety issue; YouGov Survey, 2006. Available at: http://wwwisabelhealthcarecom/pdf/USsurveyrelease-Finalpdf.Search in Google Scholar

19. Rinke M, Singh H, Ruberman S. Primary care pediatricians’ interest in diagnostic error reduction. Diagnosis 2016;3:65–9.10.1515/dx-2015-0033Search in Google Scholar PubMed PubMed Central

20. Perrem L, Fanshawe T, Sharif F, Pluddermann A, O’Neill MB. A national physician survey of diagnostic error in pediatrics. Eur J Pediatri 2016;175:1387–92.10.1007/s00431-016-2772-0Search in Google Scholar PubMed

21. MacDonald OW, Quantia MD. Physician perspectives on preventing diagnostic errors, 2011. Available at: https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0ahUKEwjO6fPZ3YjTAhUChlQKHTg_AKUQFgghMAA&url=https%3A%2F%2Fwww.quantiamd.com%2Fq-qcp%2FQuantiaMD_PreventingDiagnosticErrors_Whitepaper_1.pdf&usg=AFQjCNH_0YCUfOXe4mtPksY8g11-x1eM3A.Search in Google Scholar

22. Best Doctors, Inc. Physican’s perspective survey; measuring physician attitudes on diagnostic error and accuracy, 2012. Available at: https://bestdoctors.com/.Search in Google Scholar

23. Poon EG, Gandhi TK, Sequist TD, Murff HJ, Karson AS, Bates DW. I wish I had seen this test result earlier! Dissatisfaction with test result management in primary care. Arch Int Med 2004;164:2223–8.10.1001/archinte.164.20.2223Search in Google Scholar PubMed

24. Singh H, Spitzmueller C, Peterson N, Sawhney M, SIttig D. Information overload and missed test results in electronic health record-based settings. JAMA Internal Med 2013;173:702–4.10.1001/2013.jamainternmed.61Search in Google Scholar PubMed PubMed Central

25. Newman-Toker D, McDonald K, Meltzer D. How much diagnostic safety can we afford and how should we decide? A health economics perspective. BMJ Qual Saf 2013;22(Suppl 2):ii11–20.10.1136/bmjqs-2012-001616Search in Google Scholar PubMed PubMed Central


Supplemental Material:

The online version of this article (DOI: https://doi.org/10.1515/dx-2016-0048) offers supplementary material, available to authorized users.


Received: 2016-12-23
Accepted: 2017-3-15
Published Online: 2017-6-5
Published in Print: 2017-6-27

©2017 Walter de Gruyter GmbH, Berlin/Boston

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