VIDEO: Look at health systems, not physicians, to reduce misdiagnoses in ED
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A recent systematic review commissioned by the Agency for Healthcare Research and Quality revealed that roughly one in 18 patients are misdiagnosed in the ED each year.
Experts said that solving the problem requires systemic solutions rather than trying to “fix” individual providers.
Jonathan A. Edlow, MD, a professor of medicine and emergency medicine at Harvard Medical School and Beth Israel Deaconess Medical Center and director of the Institute for ED Clinical Quality Improvement, and Peter J. Pronovost, MD, PhD, chief clinical transformation officer of University Hospitals in Cleveland, Ohio, wrote in a JAMA editorial that “diagnosis is not always simple.”
“Some diagnoses can be made accurately at a glance; others are difficult during the first hours; and some clinical problems are even undiagnosable early in their course,” they wrote. “These diagnoses may be obvious days later, after more testing, more clinicians’ input, or simply more time, which can be the diagnostician’s friend.”
Edlow told Healio that the misdiagnosis rates in the ED are similar to those seen in primary care.
“So, you and I are, in some ways, in the same boat. We have a lot of patients coming to us. We're seeing patients relatively quickly and relatively rapidly. We don’t control exactly what comes in,” he said. “And these patients are sometimes in the earlier stages of a disease process, so diagnosis can be difficult.”
Efforts, therefore, should focus on changing the health care systems to “actually improve diagnosis,” instead of blaming individual physicians.
“If you think about your own practice ... you’re getting X-rays back. You’re getting labs back. A little nodule on a chest X-ray — that worst-case scenario — turns out to be a cancer that’s not identified and treated,” he said. “Having the ability to get a quick X-ray, or an EKG, or an MRI or a consultation in a timely fashion is another system factor that might result in something that is an understandable misdiagnosis but still a misdiagnosis.”
Edlow and Pronovost concluded that the report “should serve as a call to action.”
“Policymakers should aim for and invest in a 50% reduction in diagnostic deaths and permanent disabilities within 5 years. The engineering to accomplish this goal exists. It has been used for more than 30 years in other industries (eg, the airline industry) and in medicine (eg, reductions in infections from central venous and urinary bladder catheters),” they wrote. “The paradigm of how we interpret diagnostic errors must shift from trying to ‘fix’ individual clinicians to creating systems-level solutions to reverse system errors.”