Leapfrog makes recommendations to reduce diagnostic errors at hospitals

Leapfrog, which is a nonprofit organization founded in 2000 to promote patient safety, identified 300 potential practices that hospitals could adopt to reduce diagnostic errors. The potential practices were pared down to a list of 29 recommended practices in two categories— Organizational Leadership & Systems and the Diagnostic Process. There are 16 recommendations in the Organizational Leadership & Systems category and 13 recommendations in the Diagnostic Process category.

“It is recommended that hospitals start by identifying a small set of practices that are most feasible and/or most impactful for them and begin there. Additional practices can be added to the initial set as time goes on,” the Leapfrog report says.

The 13 recommendations in the Diagnostic Process category are as follows:

• Train all staff members involved in the diagnostic process to collect accurate health information. Using evidence-based tools and strategies to collect health information from patients and family caregivers promotes timely and accurate diagnosis.
• Hospitals should correct inaccurate diagnoses and data in the electronic health record. For example, the EHR should have a process to review and correct inaccurate diagnoses on “problem lists.”
• Hospitals should provide professional medical interpreters when patients and family caregivers have a preferred language that differs from their care team’s language. These medical interpreters, who should be available 24/7, should help get accurate health information from the patient and communicate accurate information back to the patient.
• Hospitals should provide access to radiology experts 24/7 to read and interpret urgent imaging studies as well as to consult on imaging test selection.
• On at least a quarterly basis, hospitals should have a process for radiologists and pathologists to identify and review cases where a biopsy, cytology, or autopsy result does not match clinical and imaging impressions. There should be an interdisciplinary process to reconcile these discrepancies.
• Hospitals should ensure that emergency departments have access to clinical expertise and technologies that support timely and accurate diagnosis of conditions that are often misdiagnosed and result in harm to patients.
• Hospitals should provide knowledge resources to clinicians to help them improve their diagnoses when there is diagnostic uncertainty. Clinicians should be incentivized to use these resources.
• Hospitals should train clinicians to recognize and minimize cognitive errors. For example, diagnostic performance can be improved through training on critical thinking as well as recognizing cognitive and affective bias.
• Hospitals should implement and monitor adherence to evidence-based diagnostic guidelines such as guidelines for care in the emergency department.
• Hospitals should have written policies for managing patient handoffs when there is diagnostic uncertainty such as transferring patients from the emergency department to an inpatient unit.
• There should be a policy when patients are discharged from a hospital with an uncertain diagnosis or when potential diagnoses involve high-risk conditions. Discharge summary notes should include test results and test results that are pending. The patient and family caregivers should be given condition-specific instructions on troubling symptoms, when to return to the hospital, and how to get follow-up care.
• If a patient is discharged with pending test results, hospitals should have a process in place to list the pending test results along with instructions on how to obtain the pending test results.
• Hospitals should have a written policy to promote “closed-loop” communications. The policy should specify that test results and pending test results will be viewed by care team members and communicated to the patient in a timely manner.