Hardeep Singh, MD, MPH; Laura Zwaan, PhD
Disclaimer: The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs or other funding agencies.
Acknowledgment: The authors thank Andrea Bradford, PhD, for assistance with medical editing.
Grant Support: Dr. Singh is supported by the VA Health Services Research and Development Service (CRE 12-033; Presidential Early Career Award for Scientists and Engineers USA 14-274), the VA National Center for Patient Safety, the Agency for Healthcare Research and Quality (R01HS022087 and R21HS023602), and the Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety (CIN 13-413). Dr. Zwaan is supported by the Netherlands Organization for Scientific Research (NWO-VENI grant).
Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-2042.
Corresponding Author: Hardeep Singh, MD, MPH, Michael E. DeBakey VA Medical Center, 2002 Holcombe Boulevard (152), Houston, TX 77030; e-mail, email@example.com.
Current Author Addresses: Dr. Singh: Michael E. DeBakey VA Medical Center, 2002 Holcombe Boulevard (152), Houston, TX 77030.
Dr. Zwaan: Institute of Medical Education Research Rotterdam, Erasmus MC, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands.
Singh H., Zwaan L.; Annals for Hospitalists Inpatient Notes - Reducing Diagnostic Error—A New Horizon of Opportunities for Hospital Medicine. Ann Intern Med. 2016;165:HO2-HO4. doi: 10.7326/M16-2042
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Published: Ann Intern Med. 2016;165(8):HO2-HO4.
The recent Institute of Medicine report, “Improving Diagnosis in Health Care,” has highlighted diagnostic errors as a major source of preventable harm (1, 2). Given the importance of diagnoses in the hospital, hospitalists are well-positioned to lead efforts to promote correct and timely diagnosis. However, to reduce harms from diagnostic errors, hospitalists must first understand how these errors occur and then develop practical strategies to avoid them.
Defining whether a diagnostic error has occurred can be difficult. Diagnosis evolves over time, often across multiple providers and settings. Standards for diagnostic accuracy and timeliness for most conditions are ill-defined, and physicians must constantly achieve diagnostic rigor with judicious use of tests or procedures (3). In view of these conceptual challenges, the term “error” should be used only when unequivocal evidence suggests that a key finding was missed or not investigated when it should have been. Errors should also be framed as learning and improvement opportunities, not moments for assigning blame. One definition of diagnostic error that operationalizes these concepts is missed opportunities to make a correct or timely diagnosis based on the available evidence, regardless of patient harm (4). The goal of conceptualizing errors as missed opportunities is to identify what could have been done differently in the diagnostic process and how to apply this knowledge to improve safety.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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