Diagnostic Error

Diagnostic error is a significant and under-recognized threat to patient safety. AHRQ is funding research to better understand how these errors happen and what can be done to prevent them.

AHRQ is the lead Federal agency investing in research to improve diagnostic safety. According to the AHRQ-sponsored report, Improving Diagnosis in Health Care, published by the Institute of Medicine (IOM) in 2015, most patients will experience at least one diagnostic error in their lifetime. These errors occur in all settings of care, contribute to about 10 percent of patient deaths, and are the primary reason for medical liability claims. Substantial effort is needed to identify research priorities, including how to measure and reduce diagnostic errors, and ensure this information is integrated into practice, where it will translate meaningful benefits for patients. Since 2007, AHRQ has invested in research to discover findings that advance the knowledge of diagnostic safety and to develop practical tools and resources to improve diagnostic safety.

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Research

Research Summit

The September 2016 AHRQ Research Summit on Improving Diagnosis in Health Care explored the state of the science of diagnosis in health care and discussed ways AHRQ and other stakeholders can contribute to a collaborative approach to improving diagnostic performance, as well as identify the research and evidence, tools and training, and data and measures that are needed to improve diagnostic performance.

An article in the June 2017 issue of Diagnosis, authored by members of AHRQ's patient safety team, builds upon themes from the summit by outlining key challenges and areas for potential future research and improvement related to diagnostic errors. Among them are: more robust engagement of patients as an integral part of their health care team; a deeper understanding of diagnostic errors and how to most effectively measure them; successful use of health information technology (IT) to prevent diagnostic error; and structures that optimize how organizations operate and enable better diagnoses for patients.

Studies

AHRQ has funded several recent studies on diagnostic error:

  • Outpatient diagnostic errors affect 1 in 20 U.S. adults. This study used data from three previous studies of errors in general primary care diagnosis, colorectal cancer diagnosis, and lung cancer diagnosis. The authors estimated that about half of the diagnostic errors they found could have severely harmed patients.
  • Five "rights" recommended for reducing diagnostic error in future primary care medical homes. This commentary recommends five "rights" for reducing diagnostic errors in future primary care medical homes: right teamwork, right information management, right measurement and monitoring, right patient empowerment, and right safety culture.
  • Pediatricians self-report an appreciable number of diagnostic errors. This study also finds that pediatricians are most interested in preventing high-frequency, non-life-threatening errors. A third (36%) reported no help in diagnostic error reduction from their electronic health record.

Funding Announcements Related to Diagnostic Errors

Grant funding from AHRQ has helped researchers hold annual conferences to share information about diagnostic error to advance knowledge in the field. AHRQ is interested in supporting research aimed at improving diagnosis in all settings of health care, and we are actively soliciting funding proposals for diagnostic safety research with a focus on two particularly important areas: the incidence and causes of diagnostic errors in ambulatory care; and improvement strategies and interventions. Read more about funding opportunities in improving diagnostic safety.

Tools To Improve Diagnostic Safety

Guide to Patient and Family Engagement. This guide encourages hospital patients and family members to be involved in their care. It focuses on four primary strategies for promoting patient/family engagement in hospital safety and quality of care:

  • Encourage patients and family members to participate as advisors.
  • Promote better communication among patients, family members, and health care professionals from the point of admission.
  • Implement safe continuity of care by keeping the patient and family informed through nurse bedside change-of-shift reports.
  • Engage patients and families in discharge planning throughout the hospital stay.

Improving Your Office Testing Process: A Toolkit for Rapid-Cycle Patient Safety and Quality Improvement. About 40 percent of patient encounters in primary care offices involve some form of medical test. Studies of primary care offices consistently show that the process for managing tests is a significant source of error and patient harm. This toolkit helps ensure that diagnostic lab tests are accurately managed and shared with patients and clinicians in a timely manner. The tools help examine how tests are managed in the office, from the moment tests are ordered until the patient is notified of the test results and the appropriate follow up is determined.

Questions Are the Answer: Asking questions about a diagnosis or other aspects of care is a step that patients can take to make care safer. Talking with your doctor builds trust and leads to better results, quality, safety, and satisfaction. One of the best ways to communicate with your doctor and health care team is by asking questions. Because time is limited during medical appointments, you will feel less rushed if you prepare your questions before your appointment. These AHRQ resources demonstrate how asking questions can improve care with tips on how to communicate with clinicians.

Resources To Facilitate Communication Between Patients and Clinicians: From the IOM report, "Improving Diagnosis in Health Care," this toolkit includes a checklist and other resources to help patients understand what they can to do prevent diagnostic error.

TeamSTEPPS®: Patient safety experts agree that communication and other teamwork skills are essential to the delivery of quality health care and to preventing and mitigating medical errors and patient injury and harm. TeamSTEPPS is an evidence-based program aimed at optimizing performance among teams of health care professionals, enabling them to respond quickly and effectively to whatever situations arise. This training curriculum helps clinical teams improve communication and coordination, making patient care safer.

Resources Related to Diagnostic Errors

AHRQ Views Blogs

New Coalition Broadens Efforts To Reduce Diagnostic Errors, September 2015

New Report Outlines Goals and Recommendations To Reduce Diagnostic Errors, September 2015

AHRQ's Patient Safety Network (PSNet)

Patient Safety Primer: Diagnostic Errors, August 2014
This primer provides a background on the potential causes of diagnostic errors, such as clinician cognitive biases, poor teamwork and communication, and lack of reliable systems. It also describes progress in the prevention of diagnostic errors via structured protocols for telephone triage, teamwork, communication training, and increased supervision of trainees. Finally, it discusses diagnostic error in the current context of error reporting systems and safety cultures.

Perspectives on Safety: Diagnostic Errors, March 2015
This annual review summarizes important 2014 publications on diagnostic errors. Interest in diagnostic errors gained momentum in 2014, exemplified by the launch of a new peer-reviewed, open-access journal, Diagnosis, published by the Society to Improve Diagnosis in Medicine, and the convening of a committee at the Institute of Medicine on Diagnostic Error in Health Care.

Perspectives on Safety: Diagnostic Errors in Medicine: What Do Doctors and Umpires Have in Common?, February 2007
This perspective addresses common sources of clinician diagnostic error such as context errors, availability errors, and premature closure; discusses possible solutions such as feedback and using metacognition; and concludes with advice.

Institute of Medicine (IOM) report

Improving Diagnosis in Health Care, September 2015

Learn more about diagnostic safety and what can be done to improve it.