Diagnosis

The diagnostic process is one of the most complex aspects of healthcare. Making and communicating a medical diagnosis is an imperfect science. It involves considering and ruling out alternatives, integrating patients and family members with many different healthcare professionals as diagnostic team members, and communicating complex information to patients.

In fact, it’s estimated that roughly 40,000-80,000 deaths in U.S. hospitals each year can be attributed to an inaccurate or delayed diagnosis. Every nine minutes, a person dies in U.S. hospitals due to wrong or delayed diagnosis.

What is Inaccurate Diagnosis?

Inaccurate diagnosis is the failure to establish an accurate and timely explanation of a patient’s health problems and/or communicate that explanation to the patient. These diagnoses are missed, incorrect, or should have been made much earlier.

Why Does It Occur?

Inaccurate diagnoses stem from the complexity of the diagnostic process. Many different players, including clinicians, patients, and the healthcare system itself, play parts in the diagnostic process and contribute to diagnostic quality. Sometimes, despite the best intentions, inaccurate diagnoses occur.

Members of the Coalition to Improve Diagnosis identified actions that everyone—patients, clinicians, health systems, and others—can take to improve the diagnostic process.

Obstacles to Diagnosis

In early 2018, members of the Coalition to Improve Diagnosis convened to discuss the obstacles to timely and accurate diagnosis that they have encountered day-to-day. While not an exhaustive list, they included the following:

  • Incomplete communication during care transitions – When patients are transferred between facilities, physicians or departments, there is potential for important information to slip through the cracks.
  • Lack of measures and feedback – Unlike many other patient safety issues, there are no standardized measures for hospitals, health systems, or physicians to understand their performance in the diagnostic process, to guide improvement efforts or to report diagnostic errors. Providers rarely get feedback if a diagnosis was incorrect or changed.
  • Limited support to help with clinical reasoning – With hundreds of potential explanations for any one particular symptom, clinicians need timely, efficient access to tools and resources to assist in making diagnoses.
  • Limited time – Patients and their care providers overwhelmingly report feeling rushed by limited appointment times, which poses real risks to gathering a complete history that is essential to formulating a working diagnosis and allows scant opportunity to thoroughly discuss any further steps in the diagnostic process and set appropriate expectations.
  • The diagnostic process is complicated – There is limited information available to patients about the questions to ask, or whom to notify when changes in their condition occur, or what constitutes serious symptoms. It’s also unclear who is responsible for closing the loop on test results and referrals, and how to communicate follow-up.
  • Lack of funding for research – The impact of inaccurate or delayed diagnoses on healthcare costs and patient harm has not been clearly articulated, and there is a limited amount of published evidence to identify what improves the diagnostic process.

What Obstacles to Diagnosis Have You Encountered?

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We all have a role in improving the diagnostic process. We must all ACT to improve the Accuracy, Communication, and Timeliness of diagnoses.
What ACTion are you taking?