Since To Err is Human was published in 2000, healthcare has focused upon improving patient safety; specifically, reducing errors, decreasing hospital readmissions, and creating systems to reduce harm to patients. Improving Diagnosis in Health Care1 is the latest report from the National Academies of Sciences, Engineering and Medicine (formerly, the Institute of Medicine), published in September 2015. What is particularly exciting about this report is that laboratory professionals are specifically identified as important contributors to diagnostic processes and are invited to become fully integrated members of the healthcare team. “The fields of pathology and radiology are critical to diagnosis, but professionals in these areas are not always engaged as full members of the diagnostic team”.1 (p. 361)
Medical laboratory professionals have known for a long time that laboratory test information is a critical component of the diagnostic process; however, in this report our profession was specifically recognized by others that “Enhanced collaboration among pathologists, radiologists, other diagnosticians (medical laboratory professionals) and treating health care professionals has the potential to improve diagnostic testing.”1 (p. 8)
This report identifies 8 recommendations that practitioners, health systems, governmental agencies and legal systems should undertake in order to improve diagnostic processes.
Goal #1: Facilitate more effective teamwork in the diagnostic process among health care professionals, patients and their families.
Goal #2: Enhance health care professional education and training in the diagnostic process.
Goal #3: Ensure that health information technologies (IT) support patients and health care professionals in the diagnostic process.
Goal #4: Develop and deploy approaches to identify, learn from, and reduce diagnostic errors and near misses in clinical practice.
Goal #5: Establish a work system and culture that supports the diagnostic process and improvements in diagnostic performance.
Goal #6: Develop a reporting environment and medical liability system that facilitates improved diagnosis through learning from diagnostic errors and near misses.
Goal #7: Design a payment and care delivery environment that supports the diagnostic process.
Goal #8: Provide dedicated funding for research on the diagnostic process and diagnostic errors.
Future blog posts will discuss each of these goals from the framework of how medical laboratory professionals can participate in improving the diagnostic process.
In preparation for future discussions, it is important to define diagnostic error. Diagnostic error is defined by this report as “the failure to (a) establish an accurate and timely explanation of the patient’s health problem(s) or (b) communicate that explanation to the patient”.1 (p 85) Accuracy is the foundation of diagnosis; however, two other components are included here as critical–timeliness and communicating with the patient. Medical laboratory professionals understand the importance of timeliness: we have been measuring how quickly we complete the laboratory testing process for decades. Although the speed with which we analyze specimens is important, how quickly a patient receives his or her diagnosis is also impacted by factors other than laboratory analytical speed. A diagnosis can be delayed by a provider’s lack of understanding of patient symptoms, by uncertainty about which diagnostic tests to use, by incorrect or incomplete interpretation of laboratory results, and, finally, by the process which informs the patient of the test results. This definition establishes failure to communicate with the patient to be as important as inaccuracy and delay. Many patients have been told that ‘no news is good news’ with respect to receiving information about their laboratory tests. Now that all HIPAA-covered laboratories are required to provide laboratory test result information directly to their patients, medical laboratory professionals have an opportunity to work with clinicians to improve communicating laboratory test information to patients. This new definition will help medical laboratory professionals to identify changes in post-analytic processes that can decrease diagnostic errors and improve the quality of health care.
National Academies of Science, Engineering, and Medicine. 2015. Improving Diagnosis in Health Care. Washington, D.C.: The National Academy Press.
About the Authors:
Catherine Otto is a Member of the American Society for Clinical Laboratory Science (ASCLS) Patient Safety Committee. She has taught hematology, immunology, and laboratory management in Medical Laboratory Science programs and has delivered over 50 presentations on patient safety and quality improvement at state, regional and national meetings. She currently is Dean of Health Occupations, Physical Education and Business at Shoreline Community College in Washington.
Karen Golemboski is a former Member of the American Society for Clinical Laboratory Science (ASCLS) Patient Safety Committee. She has over 30 years of experience in the laboratory, research and education, and has both published and presented sessions at state and national meetings on Patient Safety. She is the Director of the Medical Laboratory Science program at Bellarmine University in Louisville, Kentucky.