COLA, a national laboratory accreditor and advocate for quality in laboratory medicine and patient care, has recognized the findings of a Johns Hopkins study that concludes that if medical errors were tabulated similarly to diseases, they would rank as the third leading cause of death in the U.S. (with more than 250,000 deaths each year), behind only heart disease and cancer. The accreditor calls on the medical community in a press release to begin addressing the concerns raised by the study, while issuing a series of recommendations to help laboratories reduce the potential for medical errors.
The study, which was recently published in The BMJ (formerly the British Medical Journal), indicates that most medical errors represent systemic problems that include the absence of safety nets and standard protocols, poorly coordinated care, and human error. The researchers conclude that shortcomings in the International Classification of Disease (ICD) coding system for cause of death have concealed the severity of the problem, and hinder the ability to both cultivate and fund system-wide solutions.
In 2015, the National Academies of Sciences, Engineering, and Medicine (formerly the Institute of Medicine) issued a similar report entitled Improving Diagnosis in Health Care, which asserted that most people will experience at least one diagnostic error in their lifetime.
“While these medical errors are a result of inefficiencies throughout the entire system, the laboratory can play a significant role in preventing many of these errors,” said Doug Beigel, CEO of COLA. “It is estimated that laboratory testing influences approximately 70 percent of all medical decisions. Ensuring quality and excellence in the practice of laboratory medicine can go a long way in reducing overall adverse patient outcomes.”
In alignment with both the research from Johns Hopkins and the 2015 IOM report, COLA has issued the following recommendations to help laboratories reduce the potential for medical errors, and help build a systemic solution that focuses on ensuring the best quality care for patients, according to a press release from COLA:
Inter-professional Teamwork and Communication
Improved patient outcomes require an understanding of how the testing process involves institutional systems beyond the laboratory. Laboratorians can embrace teamwork and collaboration by working with clinicians to develop appropriate protocols for not only ordering but also providing interpretation of the test results. There needs to be a universal transformation of the clinical laboratory from a passive service to an active participant in patient diagnosis, treatment and management.
Laboratory Training and Education
Specimen collection, labeling, storage, and other steps of the pre-analytical testing phase account for 46 to 68 percent of laboratory errors in the Total Testing Process.[i]Yet, often allied health professionals with limited laboratory experience and training are responsible for these functions. Furthermore, over 120 unregulated point-of-care testing analytes, which contribute to diagnostic decisions, require no specialized laboratory training at all. Regardless of the complexity of the test being performed, and regardless of the level of education possessed by the person doing the testing, maintaining and following the highest quality standards should be a universal priority. The laboratory should promote increased education and training on laboratory quality to all individuals performing any type or component of the testing process.
Transparency in Reporting
A key component in both the study from Johns Hopkins researchers as well as the IOM Report focuses around the reporting of medical errors. Often these errors are concealed in fear of potential reprisals and legal action. The health care industry as a whole needs to work to build a sustainable culture of quality that recognizes errors create opportunities for improvement. In order to usher in that societal transformation, the laboratory can begin on the ground level by encouraging staff to feel comfortable self-reporting errors, conducting root cause analysis, crafting long-term solutions, and teaching others how to avoid the same errors in the future.
All professionals should urge colleagues in government and the broader health care system to conduct further research into the extent of the problem posed by medical errors. The research conducted by Johns Hopkins and the IOM open the door for further exploration into the prevalence and significance of medical errors stemming from all components of the healthcare system. In particular, COLA believes that increased research into the nearly 180,000, largely unregulated, Certificate of Waiver laboratory sites could provide valuable information to reduce medical errors and enhance patient safety. The more research unveils the existence of a systemic problem, the more potential for the knowledge and subsequent funding to cultivate those long-term and sustainable solutions.