Improving Diagnostic Safety Practices with the Safer Dx Checklist

Diagnostic errors (missed, delayed or wrong diagnoses) are a significant contributor to patient harm¹. Difficult for most healthcare facilities to identify and measure², diagnostic errors remain underreported both internally within facilities³ and externally to organizations like the Oregon Patient Safety Commission.

It is estimated that about 1 in 20 US adults experience a diagnostic error in the outpatient setting annually⁴. But it is believed that due to underreporting this estimate does not accurately reflect the frequency with which historically and structurally underserved patients experience a diagnostic error as a result of discrimination and biases within the healthcare system⁵.

We recognize that gaps in data about diagnostic errors make it challenging for healthcare facilities to identify, understand, and address their root causes. This also makes it challenging to implement strategies to address diagnostic inequities at a system-level. One way healthcare organizations can take a system-level approach to improve their diagnostic safety practices is to use shared frameworks like the Safer Dx Checklist: 10 High-Priority Practices for Diagnostic Excellence.

In October 2022, The Joint Commission Journal on Quality and Patient Safety published the research article “Developing the Safer Dx Checklist of Ten Safety Recommendations for Health Care Organization to Address Diagnostic Errors,” which led to the Safer Dx Checklist. The checklist is a self-assessment tool that healthcare organizations can use “to understand the current state of diagnostic practices, identify areas to improve, and track progress toward diagnostic excellence over time.”⁶

The Safer Dx Checklist addresses a key issue identified in in IHI’s 2020 publication Safer Together: A National Action Plan to Advance Patient Safety that continues to hinder patient safety progress: everyone is approaching patient safety independently and any learning that does occur is often siloed within organizations. Both the checklist and IHI’s national action plan highlight the importance of using a shared framework to advance patient safety across the continuum of care, and focus on the systems and infrastructure organizations have in place rather than specific solutions to individual problems.

10 Recommended Practices for Healthcare Organizations to Address Diagnostic Errors          

The Safer Dx Checklist provides ten recommended practices to help healthcare organizations achieve diagnostic excellence, offering guidance on where to focus diagnostic safety improvement efforts⁷.

1. Involve leadership in diagnostic safety efforts.

2. Promote a just culture and create a psychologically safety environment.

3. Create communication feedback loops to increase information flow.

4. Include multidisciplinary perspectives to improve root cause analysis.

5. Actively seek patient and family feedback to identify, understand, and address concerns.

6. Encourage patient and family engagement in reviewing their healthcare records.

7. Prioritize health equity in diagnostic safety efforts.

8. Encourage direct, collaborative interactions between clinical teams and diagnostic specialties.

9. Ensure reliable communication of diagnostic information between care providers and with patients and families during handoffs and transitions in care.

10. Close the loop on communication and follow up on abnormal test results or referrals.

What You Can Do

Your organization can use self-assessment tools like the Safer Dx Checklist to understand the current state of diagnostic practices at your organization, identify areas to improve, and track progress toward diagnostic excellence over time.

Learn more about the Safer Dx Checklist: 10 High-Priority Organizational Practices for Diagnostic Excellence

References

1. Graber ML. The incidence of diagnostic error in medicine. BMJ Quality & Safety; 2013;22(Suppl 2):ii21-ii27. Published June 15, 2013. Accessed April 18, 2023. https://qualitysafety.bmj.com/content/22/Suppl_2/ii21.info

2. Agency for Healthcare Research and Quality. Measure Dx: A Resource To Identify, Analyze, and Learn From Diagnostic Safety Events. Agency for Healthcare Research and Quality; 2022:1-49. Published July 2022. Accessed April 18, 2023. https://www.ahrq.gov/patient-safety/settings/multiple/measure-dx.html

3. Graber ML. The incidence of diagnostic error in medicine. BMJ Quality & Safety; 2013;22(Suppl 2):ii21-ii27. Published June 15, 2013. Accessed April 18, 2023. https://qualitysafety.bmj.com/content/22/Suppl_2/ii21.info

4. Singh H, Meyer AND, Thomas EJ. The frequency of diagnostic errors in outpatient care: estimations from three large observational studies involving US adult populations. BMJ Qual Saf. 2014;23(9):727-731. https://doi.org/10.1136/bmjqs-2013-002627

5. Giardina TD, Woodard LD, Singh H. Advancing Diagnosity Equity Through Clinician Engagement, Communication, Partnerships, and Connected Care. J Gen Intern Med; 2023; 38(5): 1293-1295. Published January 5, 2023. Accessed April 18, 2023. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9815889/

6. Hardeep S, et al. The Safer Dx Checklist: 10 High-Priority Organizational Practices for Diagnostic Excellence. Betsy Lehman Center for Patient Safety. Last Updated March 2022. Accessed April 24, 2023. https://betsylehmancenterma.gov/assets/uploads/Safer-Dx-Checklist.pdf

7. Hardeep S, et al. The Safer Dx Checklist: 10 High-Priority Organizational Practices for Diagnostic Excellence. Betsy Lehman Center for Patient Safety. Last Updated March 2022. Accessed April 24, 2023. https://betsylehmancenterma.gov/assets/uploads/Safer-Dx-Checklist.pdf