Quality and Patient Safety Division

Commonwealth of Massachusetts Board of Registration in Medicine Quality and Patient Safety Division ______________________________________________________________________________ Advisory Diagnostic Process in Inpatient and Emergency Department Settings March 2016 Background The Quality and Patient Safety Division (QPSD) has received a number of Safety and Quality Review (SQR) reports of patient events associated with delayed or missed diagnosis. This Advisory is issued to support health care facilities in the review and development of their approaches to the diagnostic process in the inpatient and emergency department (ED) settings and the overall reduction of diagnostic errors. While some references are provided, this Advisory does not include a comprehensive review of the literature; nor is it intended to provide specific recommendations for evidence‐based practice. Publication of this Advisory does not constitute an endorsement by the Board of any studies or practices described in the Advisory and none should be inferred. Overview Clinical diagnostic errors can occur in a variety of ways: a missed diagnosis, treating a patient for the wrong diagnosis, or the failure to recognize and address conflicting patient data. Diagnostic errors are common, frequently preventable and often underreported. There are an estimated 40‐80,000 deaths nationally per year from diagnostic error. In a recent survey commissioned by the Betsy Lehman Center, 23% of surveyed adults in Massachusetts reported experiencing a diagnostic error in the last 5 years, with 75% of these errors occurring during treatment at a hospital. Specialty error rates range from 2‐3% in radiology and pathology to 10‐20% for internal medicine. Diagnostic errors can be the result of the confluence of insufficient data, communication lapses, variable disease presentations, a variety of provider biases and heuristics (mental shortcuts) and other sources of cognitive error. This advisory will focus on diagnostic processes in the inpatient and emergency department settings.