The Leapfrog Group unveiled a series of recommendations Thursday for how hospitals can improve patient safety by decreasing diagnostic errors, as it moves toward rating hospitals on those errors and and making the reports public.
Earlier this year the nonprofit healthcare watchdog group announced the initiative, developed in collaboration with The Society to Improve Diagnosis in Medicine and others, and funded with a two-year, $1.2 million grant.
Leapfrog's report on suggested practices used input from clinicians, patients, health insurers and employers to assemble 29 actions hospitals can take to protect patients from harm caused by diagnostic errors.
The strategies recommended hospitals hold senior leadership accountable, support diagnostic transparency, improve staff through training and collect complete and accurate patient data, said Leah Binder, Leapfrog's president and CEO.
"Many think that this problem is so overwhelming that they might just throw up their hands and give up," Binder said. "The goal of this report is to give hospitals a place to start."
Around 250,000 hospital patients experience diagnostic errors each year, and the errors contribute to more than 40,000 deaths in adult intensive care units, a 2016 Johns Hopkins study found. Diagnostic errors also account for one-third of severe harm malpractice claims.
The majority of harmful diagnostic errors in the U.S., nearly 75%, are attributed to the categories of cancer, cardiovascular events and infection, according to research by the Society to Improve Diagnosis in Medicine.
Leapfrog defines a diagnostic error as either a diagnosis that is delayed, inaccurate, or missed, or a correct diagnosis that is not communicated to the patient and their family.
"When we talk about diagnostic error, we do not mean cognitive mistakes made by one prescriber or one clinician, because everybody makes mistakes," she said. "We are addressing what can be done to prevent harm to the patient as a result of a diagnostic error. Does the health system have in place the systems and the leadership that they should?"
To avoid instances of these errors, Leapfrog recommendations include:
- Implementing "closed-loop" communication to ensure that clinicians view test results and communicate them to patients in a timely manner, before they are discharged.
- Creating a system that makes it easy for patients and family caregivers to report diagnostic errors or concerns.
- Correcting inaccurate diagnoses and data inputted to patients' electronic health records.
- Instituting processes and structures to identify, track and analyze diagnostic errors, particularly those that result in harm or death in high-risk areas such as emergency departments, critical care units and labor and delivery units.
- Training clinicians on critical thinking, cognitive and affective bias and how to optimize clinical reasoning in the diagnostic process, while also informing care teams on how to use organizational resources such as second opinions and decision-support tools to improve diagnostic performance.
- Providing patients and family caregivers who speak a different first language with a professional medical interpreter available 24/7 on-site or via telephone or video.
- Offering discharge summary notes with test results, including those that are pending, and explicit instructions for patient follow-up care.
Leapfrog also suggested hospitals regularly report diagnostic safety events, participate in opportunities for learning, and provide clinicians and board members with feedback on diagnostic performance and progress on improvement initiatives.
Starting this fall, Leapfrog will select certain recommendations listed in the report and learn from hospitals that voluntarily share their progress with implementing the recommendations. The feedback collected will be used to develop a new section on the Leapfrog Hospital Survey set to launch in 2024.
One crucial part of Leapfrog's report is the concept of the communication resolution program, said Susan Sheridan, director of patient engagement emeritus for the Society to Improve Diagnosis in Medicine.
The program would involve healthcare teams gathering together immediately following a diagnostic error to investigate and keep the patient and family members informed and updated, she said.
Hospitals would apologize and provide for family members in need of emotional, psychological or financial support, while educating staff on how to prevent similar errors.
"We need to learn from it, because that's the number one thing patients want—that it'll never happen again," Sheridan said.