The National Quality Forum (NQF) recently released a report Improving Diagnostic Quality and Safety/ Reducing Diagnostic Error: Measurement Considerations funded by the Centers for Medicare & Medicaid Services (CMS).
The NQF convened a multi-stakeholder committee to identify recommendations for the practical application of the Diagnostic Process and Outcomes domain of the 2017 Diagnostic Quality and Safety Measurement Framework – measuring and reducing diagnostic error, and measuring and improving patient safety. This report outlines the recommendations through a series of four Use Cases that depict resolutions to specific types of diagnostic errors, and comprehensive recommendations with applications to multiple populations and setting:
- Use Case 1 – missed subtle clinical findings
- Use Case 2 – communication failures
- Use Case 3 – information overload
- Use Case 4 – dismissed patients
Diagnostic errors, which are defined as the failure to establish or communicate an accurate and timely assessment of a patient’s health problem, contribute to an estimated 40,000-80,000 deaths and 17% of adverse hospital events annually.
The report includes several recommendations related to health equity, which center around communication, cultural competency, biases and health literacy:
- Communication, Health Literacy, and Cultural Competency – Communication between the provider and the patient and between providers is a key issue in diagnostic quality and safety. When communicating with patients about their diagnoses, healthcare professionals should be sensitive to the patients’ health literacy and cultural needs or preferences. Clinicians can enhance communication using the teach-back method.
- Common biases that erode diagnostic quality and safety include social and cultural biases, as well as confirmation bias, availability bias and regret bias. Checklists, as well as simply slowing down, can minimize the impact of biases on clinical decision-making.
- Individual conditions/disease factors can contribute to communication failures. The health literacy of the patient may be a barrier to engaging and communicating with them. As clinical complexity increases, opportunities for information to be missed increase. Identify best practices, create procedures and expectations, and deploy clinician education on the use of multiple modes of communication with patients. Engage patients as active partners in information communication and follow-up. Leverage technology, data and EHRs to promote closed-loop communication and information sharing.
- Organizations should have interpreter services available for multiple languages, ensuring their specific patient populations are able to effectively communicate with the clinical team, either in person or via telephone or computer software. Measure the use of language interpreter services in patients’ preferred languages. Ensuring that patients communicate in their preferred language is important to ensure understanding, and measuring the use of interpreters may help improve communication.