Last week, on September 22nd, the Institute of Medicine (IOM) announced the publication of its report, Improving Diagnosis in Health, a follow-up to To Err is Human and Crossing the Quality Chasm. Improving Diagnosis in Health Care, builds on concepts from earlier IOM reports, but this publication hits even closer to home for those of us involved in diagnostic testing. The report begins by highlighting the scarcity of evidence regarding diagnostic error, in sharp contrast to its prevalence. Most people, the IOM predicts, will encounter at least one diagnostic error during their lifetime (defined as the “failure to establish an accurate and timely explanation of a health problem or to communicate that explanation to the patient”). The report considers how to define, track, and prevent diagnostic errors, with an emphasis on incorrect or delayed diagnoses, as opposed to over-diagnosis, which is acknowledged to be interrelated.
Possibly the most novel part of the report is the inclusion of the patient as an integral part of the diagnostic process. In defining goals to improve diagnostic accuracy, the IOM suggests that we can take advantage of four important trends in healthcare today: the interest in improving patient safety; increased patient involvement; attention to professionalism among healthcare professions; and improved collaboration among healthcare professionals. Building on this momentum, the IOM has identified 8 goals to improve diagnosis and reduce diagnostic error:
- increase effective teamwork (among professionals and with patients),
- improve education in the diagnostic process,
- use health information technology to aid diagnosis,
- identify and track diagnostic errors,
- create work systems which support improved diagnosis,
- construct a reporting system as a method to learn from diagnostic errors,
- develop payment systems that sustain diagnostic improvements, and
- provide research opportunities in diagnostics. (Box 9-1 on p. 9-3)
For laboratory professionals, the most significant piece of information is the IOM’s acknowledgment of the critical role of pathology and laboratory scientists in the diagnostic process. Continuing to relegate laboratory services to an ancillary role, the report states, will hamper efforts to improve diagnosis, and further engagement is encouraged “to improve all aspects of the diagnostic testing process” (p. 9-5). Although the report specifically names the pathologist as the doctoral level professional in this process, the description of the services expected is a perfect fit for the new doctorally-prepared laboratory scientist, the Doctor of Clinical Laboratory Science (DCLS).
What does this report mean for laboratory professionals in practice? Two key take-home points:
- This report is a declaration that patient safety is the responsibility of all healthcare professionals, including laboratory scientists. We are expected to engage with patients and their families, as well as with other professionals, to decrease diagnostic errors and to improve patient health outcomes.
- For decades, we have professed a desire to apply all that we know to aid in diagnosis and treatment. Consider this report your request to do so – the IOM has asked us to participate in patient care to the highest extent of our professional abilities! Within each facility, we can work to identify ways to improve the diagnostic process (which will also impact other IOM quality aims such as effectiveness and efficiency). We can work with Information Technology in our organizations to track test utilization, increase education outreach to care providers, consult with individual diagnosticians, and develop patient education materials. You don’t need to wait for an invitation – the Institute of Medicine has just announced that we need to join the process.
National Academies of Science, Engineering, and Medicine. 2015. Improving Diagnosis in Health Care. Washington, D.C.: The National Academies Press.
The book is available for download or purchase at the National Academy Press website: www.nap.edu.
A video presentation discussing the report may be found at: http://iom.nationalacademies.org/Reports/2015/Improving-Diagnosis-in-Healthcare.aspx.