Report: Prevalence of Diagnostic Errors

A report published last week by the Institute of Medicine finds most people will experience a significant diagnostic error in their lifetime.

The nearly 400-page report, “Improving Diagnosis in Health Care,” found that at least one in 20 patients who seeks outpatient care each year experiences a diagnostic error. About 10 percent of patient deaths stem from a delay in diagnosis or a wrong diagnosis.

What About Pediatrics?

But what about pediatrics specifically? The diagnostic process in children is often very different than that associated with adult illness. And diagnostic errors in children are often associated with unique factors in pediatrics, such as systems and patient/caregiver issues, physician training, and practice workflow.

In a 2010 report published in Pediatrics, more than half of 1,360 pediatricians surveyed said they made a diagnostic error at least once or twice a month (the frequency was 77 percent among trainees). And nearly half reported diagnostic errors that harmed patients at least once or twice a year.

Failure to gather information through history, physical examination or chart-review was the most common system factor reported, according to the report.

Among the recommendations in the 400-page report is for better communication to take place among health care providers and their patients. Also, Physicians in the 2010 study ranked access to electronic health records and following up with patients as effective strategies in preventing diagnostic errors.

But while EHR's and other more sophisticated diagnostic tools, such as ICD-10, are hoped to stave off errors, their usefulness is questioned. Some physicians and academics argue that tools like these already assume the correct diagnosis was made in the first place.

Pediatric practice management Consultant Chip Hart echoes this stance.

“I think it's about the docs not getting it right versus something like putting in the right ICD10 code,” Hart says.

The Institute of Medicine's recent report outlines eight goals for improving diagnostic outcomes in general:

* Facilitate more effective teamwork among clinicians, patients, and their families

* Enhance professional education and training

* Ensure health IT supports patients and clinicians

* Develop and deploy approaches to identify, learn from, and reduce diagnostic errors.

* Establish a work system and culture that supports improvements

* Create a reporting and medical liability system that facilitates improvement

* Design payment and care delivery environment to support diagnostic process

* Provide funding for research on the diagnostic process and errors

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