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Promoting Action on Diagnostic Safety: The Safer Dx Checklist

Published:August 28, 2022DOI:https://doi.org/10.1016/j.jcjq.2022.08.010
      In the decade after the National Academy of Medicine's To Err Is Human report,
      Institute of Medicine
      To Err Is Human: Building a Safer Health System.
      there was a wealth of research as well as large collaboratives that aimed to reduce hospital-acquired conditions such as catheter-associated bloodstream infections.
      • Shekelle PG
      • et al.
      The top patient safety strategies that can be encouraged for adoption now.
      ,

      Agency for Healthcare Research and Quality. Making Health Care Safer II: An Updated Critical Analysis of the Evidence for Patient Safety Practices. Shekelle PG, et al. Evidence Reports/Technology Assessments, no. 211. Mar 2013. Accessed Aug 30, 2022. https://www.ncbi.nlm.nih.gov/books/NBK133363/.

      However, diagnostic error research, and hence programmatic efforts to reduce diagnostic errors, has lagged substantially behind other safety research. Why the slow start? First, diagnostic errors are hard to measure. They are complex, multifactorial events that can happen during any encounter with the health system. In fact, many high-consequence errors occur over multiple encounters in the ambulatory environment, emergency department, and subspecialty clinics. The 2015 Academy report Improving Diagnosis in Health Care anchored diagnostic error on the patient, defining it as “the failure to (a) establish an accurate and timely explanation of the patient's health problem(s) or (b) communicate that explanation to the patient.”
      National Academies of Sciences, Engineering, and Medicine
      Improving Diagnosis in Health Care.
      (p. 85) Yet questions remain regarding how to adjudicate what is accurate and timely, particularly in the face of unusual presentations and/or rare conditions.
      • Singh H
      • et al.
      Recommendations for using the Revised Safer Dx Instrument to help measure and improve diagnostic safety.
      ,
      • Singh H
      • Sittig DF.
      Advancing the science of measurement of diagnostic errors in healthcare: the Safer Dx framework.
      Finally, diagnostic error can feel deeply personal. As physicians ourselves, we have been involved in numerous safety events, yet none stand out like the patients with delayed detections of appendicitis, meningitis, or malignancy. Experiences of this kind may have fueled denial or created resistance to early diagnostic error research, but that denial and resistance make it all the more critical that these common errors are rapidly and systematically addressed.
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