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Patient safety efforts may prevent diagnostic errors

By Genevra Pittman

NEW YORK (Reuters Health) - Electronic alerts and other technology-based aids may help prevent costly missed or delayed diagnoses, according to a new review of past evidence.

"I think there's a general feeling that we're probably going to need multiple strategies," said Dr. David Newman-Toker, who studies diagnostic errors at the Johns Hopkins University School of Medicine in Baltimore but was not involved in the study.

He gave as examples computer programs that generate a list of possible diagnoses based on patient symptoms or policy initiatives that reward doctors for making correct diagnoses.

For years researchers have known about the dangers of medication prescribing errors and mistakes in the operating room. And last week, another team of scientists reported that diagnostic errors are common in primary care and may put patients at risk for serious complications (see Reuters Health story of Feb 26, 2013 here: http://reut.rs/YxG9WC).

But, according to the researchers behind the new analysis, most studies have not tracked whether patient safety efforts aimed at preventing such mistakes directly improve patient health down the line, or considered their costs and possible harms.

For their review, Dr. John Ioannidis from the Stanford University School of Medicine in California and his colleagues analyzed 109 studies, including 14 randomized trials looking at the rate of diagnostic errors and related outcomes with or without specific patient safety strategies.

Those strategies included educating patients and doctors about specific symptoms to watch out for and enhancing practices for assessing certain types of patients.

Most trials showed some improvement in diagnostic accuracy or patient management tied to the intervention. For example, one 1992 study found a nine-percent reduction in the number of misdiagnoses and incorrect hospital admissions for appendicitis when doctors used a standardized data form to interpret patients' abdominal pain.

Technology-based systems, such as text message alerts sent to doctors, were one of the most promising strategies, the researchers wrote Monday in the Annals of Internal Medicine.

However, a different study out this week showed that doctors may miss such alerts when they're feeling information overload (see Reuters Health story of March 5, 2013 here: http://reut.rs/YUubGM).

"Ultimately I think the biggest bang for the buck is going to come out of decision-based computer support of one kind or another, but it's not going to be easy, and it's not going to be tomorrow," Newman-Toker told Reuters Health.

The new report is part of a journal issue devoted to improving patient safety.

Newman-Toker said the most important change at present would be to mandate that doctors record what symptoms a patient displays and describes in the initial exam, and record the doctor's diagnosis. That would help researchers in the future get a better idea of how common diagnostic errors truly are and what contributes to delays or mistakes in primary care.

SOURCE: http://bit.ly/166o0of Annals of Internal Medicine, online March 4, 2013.

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