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In September 2015, as a continuation of the Institute of Medicine’s (IOM) work to improve quality and safety in health care, the report, “Improving Diagnosis in Health Care” was released.  The IOM committee examined current definitions and examples of diagnostic error; the epidemiology, burden of harm, and costs associated with diagnostic error, as well as current efforts to improve diagnosis. 

One of the conclusions detailed in the IOM report cited  ”most people will experience at least one diagnostic error in their lifetime, sometimes with devastating consequences”….and that “urgent change” is needed to address this issue.  Diagnostic errors cause harm by delay of appropriate treatment, providing unnecessary or harmful treatment, or causing emotional/financial harm. (Report in Brief, “Improving Diagnosis in Health Care: Quality Chasm Series”, 2015, National Academy of Sciences).  The IOM report outlines 8 comprehensive goals with recommendations to accomplish each goal. 

The first goal is to “Facilitate more effective teamwork in the diagnostic process among health care professionals, patients, and their families’.    The recommendations regarding this goal seem to be fully consistent and aligned with those of CARe/MACRMI efforts.  Recommendation 1B states:  “Health care professionals and organizations should partner with patients and their families as diagnostic team members and facilitate patient and family engagement in the diagnostic process, aligned with their needs, values, and preferences” ….and to” provide patients with opportunities to learn about the diagnostic process, ….create environments in which patients and their families are comfortable engaging in the diagnostic process and sharing feedback and concerns about diagnostic errors and near misses…..ensuring patient access to EHR’s, including clinical notes and …test results, to facilitate patient engagement in the diagnostic process and patient review of health records for accuracy…..identify opportunities to include patients and their families in efforts to improve the diagnostic process by learning from diagnostic errors and near misses”.  (IOM Fact Sheet, “Recommendations 2015 Improving Diagnosis in Health Care” National Academies of Sciences-Engineering-Medicine 2015).

The engagement of patient and family as principal partners in the health care process is one of the cornerstones of patient-centered care.  As we move to be transparent regarding outcomes of care, it is important to review the patient experience from the inception of care and the beginning of the provider-patient relationship.  A strong partnership between provider and patient from the start of the care relationship throughout the diagnostic and treatment processes,  moving toward an interactive dialogue between patient and provider, and providing clear options for alternatives, will likely lead to improved outcomes and an improved patient/family experience with care.


Carolyn Gifford, MS, RN

Risk and Patient Safety Specialist

Beth Israel Deaconess Hospital, Needham

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