Diagnostic errors are a major cause worldwide of preventable patient harm. Estimates vary, but a new study published online in BMJ Quality and Safety looked at diagnostic errors in hospitals and other clinical settings and concluded that these errors result in some 795,000 Americans becoming permanently disabled or dying due to misdiagnosis from just three major disease categories-cancers, vascular events, and infections.
Within these categories, the researchers focused on stroke, venous thromboembolism, arterial thromboembolism, aortic aneurysm/dissection, myocardial infarction, sepsis, pneumonia, meningitis/encephalitis, spinal abscess, endocarditis, lung cancer, breast cancer, colorectal cancer, melanoma, and prostate cancer. According to the study, which the authors note is the first national estimate of its kind, 15 diagnoses account for more than half of all diagnostic errors. The disease with the highest rate of death and permanent disability associated with false negative diagnosis was stroke.
Nurses and, in particular, NPs, are well positioned to improve diagnostic precision because of their hands-on role in patient care. Of all professionals on the clinical team, nurses spend the most time providing direct patient care, including monitoring of conditions and any changes which may occur-information vital to accurate diagnosis. Diagnosis is also an inherent part of the NP's role.
Yet, barriers continue to block nurses from realizing their potential to reduce diagnostic errors and improve patient outcomes. The barriers aren't entirely institutional. Experts say nursing schools urgently need to revamp curricula to improve students' knowledge of diagnostic criteria, and the profession must prioritize skill building to enable nurses to participate effectively on clinical teams. In some nursing specialties-notably, emergency and intensive care-collaborative clinical teams already are the norm, but other clinical areas lag in this regard.
The Society to Improve Diagnosis in Medicine cites progress in strengthening nurses' roles as integral team members to achieve diagnostic excellence, but also points to barriers to achieving full partnership: a resistant health care system, reluctance to change established patterns, and pushback against a potential realignment of professional roles.
Deficits in nursing education were highlighted in the May-June 2021 Nursing Outlook by researchers who noted a "misperception" in the profession that "nursing observations and interpretations are separate and distinct from the diagnostic process." The researchers added that "considering the need to aggressively confront the problem of diagnostic errors, we believe that nurses are essential members of the diagnostic team and should enter practice with the expectation to participate actively and meaningfully in the diagnostic process, and that nursing education should prepare them to assume this responsibility and accountability." They noted that nurses' hands-on role with patients positions them to observe subtle shifts in condition and alert the rest of the care team. "[Nurses] are in an ideal position to partner with patients to ensure accurate, subjective and objective data gathering and to monitor the accuracy of a diagnosis and to prevent diagnostic errors."
In its landmark 2015 report, Improving Diagnosis in Health Care, the National Academies of Sciences, Engineering, and Medicine called for better teamwork to prevent diagnostic errors, but conceded that nurses' roles were not always embraced as part of this effort. The National Academies also recommended better curricula in nursing schools to address the importance of diagnosis and collaboration, along with ongoing education and training in the diagnostic process, underscoring the importance of teamwork and patient-provider communication. And it strongly encouraged administrators to embrace a culture that values open discussion and feedback on diagnostic performance.
As these operational and systemic barriers are overcome, nurses in all care settings will find new responsibilities as well as opportunities to provide valuable input on medical diagnosis and help reduce preventable patient harm.-Liz Seegert