Measuring Diagnostic ErrorsApril 5, 2018
Research shows that close to 12 million Americans are impacted by diagnostic errors each year, one-third of which result in serious injuries, disabilities, or even death. A researcher from Johns Hopkins’ Armstrong Institute for Patient Safety and Quality has developed a new method for measuring and monitoring diagnostic errors to reduce the incidence of medical misdiagnosis and improve the quality of care. The approach, called Symptom-Disease Pair Analysis of Diagnostic Error, or SPADE, allows researchers to measure diagnostic errors and negative outcomes so performance can be tracked and effective interventions can be determined.
According to David Newman-Toker, M.D., Ph.D., director of the Armstrong Institute Center for Diagnostic Excellence, diagnostic errors are a serious issue, and the SPADE method provides a way to operationally measure them. Prior to this new method, the only way to measure diagnostic errors was for hospital staff members to conduct extremely labor-intensive reviews of medical records. The SPADE method combs through large databases containing hundreds of thousands of patient visits to identify common symptoms that caused a patient to see a doctor. The method then pairs those symptoms with one or more diseases that could be misdiagnosed in those clinical contexts. For example, says Newman-Toker, the method can be used to measure how often a patient comes to the hospital suffering from dizziness and is diagnosed with an inner-ear condition, but the dizziness was actually a symptom of a major stroke. Using the database, researchers can also measure how frequently a patient with a fever is diagnosed with a viral infection only to be admitted later with bacterial sepsis.
Mistakes Cost Lives
SPADE may also lead to improved patient outcomes, according to Newman-Toker. Too often, quality control measures focus on charts and hospital processes when they should be focusing on patient outcomes. When hospitals track adverse results, such as strokes or heart attacks, it matters to patients.
While additional research is necessary to determine whether SPADE can be used across a wide range of symptoms and diseases, Newman-Toker believes this method will work for the three most common causes of disability and death from diagnostic errors: vascular events, infections, and cancers. It may take time for physicians and hospitals to be willing to adopt a system that tracks diagnostic errors, but Newman-Toker believes it will provide patients with the opportunity to choose a hospital that has fewer misdiagnosis-related deaths. Patients can feel a sense of empowerment that they never had before. Ultimately, SPADE may be among hospitals’ publicly reported measures.
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