Improving diagnostic safety - where should healthcare organizations start? CERC suggestions and our own

Research over the past decades has established diagnostic errors to be the foremost patient safety challenge in health care today; the harm related to diagnostic errors is unacceptably high. We now understand where, when, and why these errors arise, and a wide range of interventions to improve diagnostic safety and quality are now being proposed, focusing on both the system-related, and personal, cognitive aspects of the diagnostic process. Stanford University's Clinical Excellence Research Center (CERC) has done a great service to the field by convening an expert panel to provide consensus recommendations on economically-beneficial interventions that would have the greatest clinical impact. The CERC report identified these 3 areas as the top priorities: 1 - Optimizing patient navigation and care coordination; 2 - Providing clinicians with decision support resources; and 3 - Creating diagnostic 'safety nets' to close the loop on abnormal, critical test results. Although the CERC recommendations represent state-of-the-art, authoritative advice, we believe there are 3 other interventions that have comparable financial and clinical impact profiles: 1 - Finding and learning from diagnostic errors; 2 - Improving clinical reasoning; and 3 - Promoting patient engagement. Healthcare organizations have an obligation to begin improving diagnostic safety and quality, and both the CERC recommendations and our own represent excellent options that should be considered for immediate adoption.