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For the third year in a row, diagnostic errors topped ECRI's list of safety issues that pose the greatest risk for patients.
In its ninth annual report listing leading patient safety concerns for the year, the not-for-profit patient safety organization selected missed and delayed diagnosis as the biggest problems. Diagnosis errors also topped the lists released in 2019 and 2018.
"We continue to be concerned that the outright errors in diagnostic procedures or delays in communicating diagnostic findings contribute significantly to preventable medical errors," said Dr. Marcus Schabacker, CEO of ECRI.
Diagnosis mistakes are among the most common errors in healthcare and the leading cause of malpractice claims. Despite this, it's an issue that hasn't been widely focused on, Schabacker said.
"Healthcare leaders need to realize and acknowledge that this is actually a problem, that is step number one," he said. "Once you recognize and acknowledge it's a problem, you can do something about it, and there are things you can do about it."
There are solutions to diagnostic errors right now but they mostly address low-hanging fruit such as closing communication gaps in test results, said Paul Epner, CEO of the Society to Improve Diagnosis in Medicine. Research indicates clinical judgment is the leading cause of diagnostic errors, which "is not a simple thing to fix at all," Epner said.
"It's not a matter of telling doctors, nurses and clinical teams to just try hard, that isn't going to get it done," he added.
There is growing interest in fixing diagnostic errors. Membership of a coalition led by the Society to Improve Diagnosis in Medicine has steadily grown to about 60 healthcare organizations. ECRI is listed as a participant. Additionally, a bipartisan group of congressmen introduced a bill in November that would establish centers for research on improving diagnosis.
"We are making progress even though it's slow," Epner said.
ECRI's annual list is created with input from about 40 ECRI-employed and external patient safety experts. Data from ECRI's patient safety organization is also used, which includes 1,800 healthcare organizations such as health systems and hospitals. The list isn't necessarily reflective of the most frequent patient safety errors but rather topics that have the most opportunity for healthcare organizations to address.
ECRI's second concern was maternal health across the care continuum. Schabacker said while there has been more awareness in recent years about the nation's high maternal mortality rate, there hasn't been improvement.
The maternal mortality rate for 2018 was 17.4 deaths per 100,000 live births, according to the most recent data from the Centers for Disease Control and Prevention, which is higher than other high-income countries.
ECRI recommends better care coordination between hospitals and outpatient settings considering about two-thirds of pregnancy related deaths occur postpartum.
"All healthcare providers for women of childbearing age have an important role to play in ensuring their health and safety," said Carlye Hendershot, senior patient safety analyst at ECRI, in the report.
In light of the coronavirus outbreak, Schabacker also highlighted ECRI's concern about antimicrobial resistance, which ranked eighth on the list.
Although there is raised awareness about the importance of antimicrobial stewardship, antibiotics are still used unnecessarily, particularly in long-term care, urgent care centers and dentist offices, according to ECRI.
Schabacker said misuse of antibiotics will likely rise because of COVID-19. Research shows patients are commonly given unnecessary antibiotics for upper respiratory infections.
"In light of the coronavirus situation it's important that we keep an eye on antimicrobial stewardship practices," Schabacker said.