Clinical Laboratories Reduce Diagnostic Errors
The Institute of Medicine, a division of The National Academies of Sciences, Engineering, and Medicine (NASEM) published Improving Diagnosis in Health Care in September 2015 (http://iom.nationalacademies.org). This publication is a sequel to their landmark report in 2000, which was entitled, To Err Is Human: Building A Safer Health System. The authors of the most recent study concluded that little progress has been made in reducing diagnostic errors during the past 15 years.
The committee defined diagnostic error as “the failure to (a) establish an accurate and timely explanation of the patient’s health problem(s) or (b) communicate that explanation to the patient". Diagnostic errors may cause harm to patients by preventing or delaying appropriate treatment, providing unnecessary or harmful treatment, or resulting in psychological or financial repercussions.
IOM estimated that 5 percent of U.S. adults who seek outpatient care each year experience a diagnostic error. Postmortem examination research spanning decades has shown that diagnostic errors contribute to approximately 10 percent of patient deaths, and medical record reviews suggest that they account for 6 to 17 percent of adverse events in hospitals. Diagnostic errors are the leading type of paid medical malpractice claims and are almost twice as likely to have resulted in the patient’s death compared to other claims.
IOM concluded that diagnostic errors have a wide range of causes, including poor collaboration among clinicians, patients, and their families; a healthcare work system that is not well designed to support the diagnostic process; limited feedback to clinicians about their diagnostic performance; and a culture that discourages disclosure of errors.
On September 23, The Washington Post published an article entitled, “Study: Most Americans will get at least one wrong diagnosis,” which highlighted the risks identified in the IOM report.
In response to this article, David D. Koch, president of the American Association for Clinical Chemistry wrote a Letter to the Editor of the Washington Post on September 27, entitled, “Medical labs can help prevent diagnostic errors”.
Dr. Koch pointed out that the IOM report called for better communication among the health care team and with patients and that more frequent communication between clinical laboratory professionals and clinicians will reduce diagnostic errors. Collaboration with the clinical laboratory avoids diagnostic errors by ensuring that patients know what to do before specimen collection, that doctors order the most appropriate laboratory tests and that results are interpreted correctly.
I congratulate Dr. Koch for writing this editorial. The public needs to understand the important role that pathology and laboratory medicine plays in ensuring accurate diagnosis and treatment.
