The imperativeness of improving diagnosis for patient safety

Dr. Meenakshi Hariharan

(meenakshihariharan79@gmail.com)

Patient safety stands at the forefront of quality healthcare, emphasizing the fundamental principle of medicine—”first do no harm.”  Adverse events that are the unwanted result in any step of treatment endanger patient safety. Discussions about diagnosis have long focused on such concerns as sensitivity and specificity, cost, and the role of new technology. Relative to these issues, matters related to patient safety in diagnosis have received less attention, even though failures in the diagnostic process harm many patients. Although it is a complex, largely cognitive process that solely contributes substantially in identifying a patient’s health problem, the role of diagnosis is undervalued as it is more difficult to evaluate and measure than many of the other parts of the patient safety agenda, such as falls, wrong-site surgery, nosocomial infections, and medication errors. However, the magnitude of diagnostic errors is profound worldwide, accounting for nearly 16% of preventable harm across health systems. With most adults likely to face at least one diagnostic error in their lifetime, substantial work needs to be done to improve the safety of diagnostic processes.

A diagnostic error is the failure to establish a correct and timely explanation of a patient’s health problem, which can include delayed, incorrect, or missed diagnosis, or a failure to communicate that explanation to the patient. Systemic factors are organisational vulnerabilities that predispose to diagnostic errors, including communication failures between health workers or health workers and patients, heavy workloads, and ineffective teamwork. Cognitive factors involve clinician training and experience as well as predisposition to biases, fatigue, and stress.

Timely and accurate diagnosis is foundational to good clinical practice and plays a pivotal role in achieving optimal patient safety and outcome. To reach a diagnosis, patients and their health care teams must work together to navigate the complex and sometimes lengthy diagnostic process. Patient safety is often compromised by the downstream consequences of erroneous, untimely, and miscommunicated diagnoses and errors in the use and performance of diagnostic tests. Errors can occur at any stage. An incorrect, missed, or delayed diagnosis can result in the patient not receiving the necessary medical care, which can lead to further health problems or complications. Unnecessary treatment or the prescription of medication that is not necessary poses significant health risks too, causing prolonged illness and sometimes can cause disability or even death.

Diagnostic safety henceforth plays a crucial role in patient safety, and it also enables early detection of diseases. This helps to treat serious health problems at an early stage, which improves the chances of recovery and can reduce healthcare costs. It also helps to use resources more efficiently. Medical resources such as time, personnel, equipment, and financial resources can be used more effectively when the diagnosis is certain and accurate.

 In addition, a reliable diagnosis helps maintain patients’ trust in the healthcare system and healthcare professionals. A loss of trust can lead to uncertainty, dissatisfaction, and poorer compliance with medical instructions. Furthermore, when patients understand that their diagnosis is correct, they are more willing to actively participate in their own healthcare. This includes adhering to treatment plans, implementing lifestyle changes, and collaborating with the treatment team. Overall, a secure diagnosis goes a long way in ensuring that patients receive the best possible care and treatment, which ultimately improves their safety and well-being.

Taking into consideration the diagnostic safety issues, the global patient safety action plan 2021-2030 highlighted the need for ensuring the safety of diagnostic processes, encouraging countries to adopt strategies that reduce diagnostic errors, which often arise from a combination of cognitive and system factors that impact the recognition of patients’ key signs and symptoms, and the interpretation and communication of their test results.

World Patient Safety Day, one of WHO’s global public health days, observed annually on 17 September, is the cornerstone of action to promote global health and safety. It’s objectives are to increase public awareness, foster collaboration between patients, health workers, policymakers, and health care leaders, enhance global understanding, and work towards global solidarity to promote patient safety. Each year, a new theme is selected to celebrate this day to highlight a priority patient safety area needing urgent and concerted action. Recognising the critical importance of correct and timely diagnoses in ensuring patient safety and improving health outcomes, “Improving diagnosis for patient safety” with the slogan “Get it right, make it safe!” has been selected as the theme for World Patient Safety Day 2024.

Through the slogan “Get it right, make it safe!” WHO calls for concerted efforts to significantly reduce diagnostic errors through multifaceted interventions rooted in systems thinking, human factors, and active engagement of patients and families. Health workers, healthcare leaders, policymakers, and civil society will emphasise the pivotal role of correct and timely diagnosis in improving patient safety. These interventions include but are not limited to ascertaining a complete patient history, undertaking a thorough clinical examination, improving access to diagnostic tests, implementing methods to measure and learn from diagnostic errors, and adopting technology-based solutions.

Objectives of World Patient Safety Day 2024

1. Raise global awareness of errors in diagnosis contributing to patient harm and emphasize the pivotal role of correct, timely, and safe diagnosis in improving patient safety.

2. Give prominence to diagnostic safety in patient safety policy and clinical practice at all levels of health care, aligned with the Global Patient Safety Action Plan 2021–2030.

3. Foster collaboration among policymakers, health care leaders, health workers, patient organisations, and other stakeholders in advancing correct, timely, and safe diagnosis.

4. Empower patients and families to actively engage with health workers and health care leaders to improve diagnostic processes.

World Patient Safety Day 2024 proposes a wide range of activities, such as national campaigns, social media activities, advocacy, and technical events, which will be organized on and around 17 September. 

Patient safety is not just a healthcare term; it’s a universal right. As we commemorate World Patient Safety Day 2024, let’s recognize the unsung heroes working tirelessly behind the scenes who have led the charge for ensuring patient safety and quality of care by establishing a highly reliable and resilient system for accurate diagnosis of any disease in the shortest possible time that engages deeply with the patients, incorporating patient safety and quality programs, improving patient/family and clinician communication, reducing errors and harm throughout the diagnostic journey, and reshaping healthcare for a safer tomorrow.