Five percent of U.S. adults who receive healthcare in an outpatient setting will experience a diagnostic error during their lifetime1. To minimize this number and improve healthcare quality, it is important to increase funding for research on the diagnostic process and diagnostic errors, and it is critical that laboratory professionals are included in research that includes laboratory testing.

Currently, most research funding is disease-focused and devoted to the treatment of specific disorders and disease states.  This continues to be important research, but treatment is ineffective and can even be harmful without an accurate diagnosis2. Five potential areas of research to improve the diagnostic process have been identified:

Engagement of patients and families in the diagnostic process2;

Outcome of the education and training for health care professionals2;

Incorporation of health information technology to improve the diagnostic process2;

Methods to identify, analyze and reduce diagnostic errors2;

Examination of the role the health care delivery work environment contributes to diagnostic errors2;

Assessment of the external environment as a factor in diagnostic errors. 2

Patient-centered care relies on full participation of patients and their families in the diagnostic process. Patients and families who understand the process of care are better advocates for themselves. As medical laboratory professionals we know it is important for people to understand the purpose of tests being performed.   Evaluating the role of medical laboratory professionals in providing patients with information about their testing can determine if patient safety is improved.

Healthcare delivery requires a multi-disciplinary approach that involves many professionals.  How healthcare professionals are educated is as important as what they are taught and what they learn.  It is important to examine whether this model of preparing future practitioners improves the quality of healthcare and more importantly, whether it reduces diagnostic errors.

At a minimum, health information technology reduces clerical errors. More sophisticated health information technology systems, particularly those that are linked to other systems, can provide an alert when the medication prescribed does not fit with the susceptibility testing reported by the medical laboratory professional, provide test results for procedures when ordered more frequently than clinically appropriate, or create lists of actions to be taken, such as clinical practice guidelines when a patient presents with a specific diagnosis or set of symptoms.  It requires research to demonstrate that these systems are effective, improve patient safety, and reduce diagnostic error.

The environment in which healthcare is delivered has an impact on patient care.   Determining the components of the culture of patient safety and their specific impact on diagnosis and treatment is vital to improving healthcare delivery environments.  This will then inform health professional educational programs with specifics on additional competencies required of future practitioners.

Access to healthcare has an impact on diagnosis.  Without health insurance, individuals are reluctant to visit their healthcare provider because of the cost.  More research needs to be done to determine the impact of care delivery models and payment and reimbursement methods on diagnosis and diagnostic errors. It is also important to study the impact diagnostic errors have upon individuals, the healthcare delivery system, and society in general.

Allocating funds to examine diagnostic errors and identify systems to decrease these types of errors is as important as other funding allocated to medical research by the federal government.  We have been focusing upon improving patient safety for 17 years since the Institute of Medicine published To Err is Human; we are long overdue in addressing this critical area in healthcare delivery.  It is essential that laboratory professionals participate and contribute to improving diagnosis and decreasing diagnostic error.

 

1.)    Singh H, Meyer AND, Thomas EJ The frequency of diagnostic errors in outpatient care: estimations from three large observational studies involving US adult populations BMJ Qual Saf 2014;23:727-731.

2.)    National Academies of Sciences, Engineering, and Medicine.  2015.  Improving diagnosis in health care.  Chapter 8 A Research Agenda for the Diagnostic Process and Diagnostic Error, pp 343–353.  Washington, DC:  The National Academies Press.