The Problem

A fecal immunochemical test (FIT) non-invasively tests for colorectal cancer (CRC). FITs help identify patients in need of diagnostic colonoscopies, but follow-up care may be difficult for vulnerable patient populations to carry out, which exacerbates their susceptibility to CRC. FITs generally remain underutilized, especially among racial/ethnic minority and low-income populations, which makes these groups disproportionately susceptible to CRC risk.

Abnormal subcritical tests may not require immediate attention, but missed or delayed follow-up of these tests can lead to patient harm. Research on the topic suggests that new technology and workflow solutions are needed. Therefore, at ASCENT, we sought provider perspectives on the barriers and facilitators to managing subcritical test results. We conducted five focus groups with 43 multidisciplinary clinicians in an urban, academic, integrated, safety-net health system.

A recent analysis published in BMJ by Dr. Martin Markary and Michael Daniel highlight the fact that medical error is not reported on death certificates or in rankings for cause of death. Their estimate of patient deaths associated with medical error place it as the third most common cause of death in the US after heart disease and cancer, based on comparisons to causes of death compiled by the CDC. They urge systems to move towards collecting better data for research and prevention efforts.

Health information technology (HIT) solutions are proven to be successful in improving patient safety in certain settings. For example, the implementation of computerized medication prescribing tools coupled with a barcoding system can reduce medication errors. However, it is inconclusive whether or not these HIT solutions are successful across settings.

The patient safety movement has evolved with a “no blame” culture in its approach to error management, focusing on system-level failures rather than those of the individual. In their Perspective on Safety, Dr. Christopher Moriates and Dr. Robert M.

A 2015 report from the Institute of Medicine, "Improving Diagnosis in Health Care," identified existing gaps in our health care system's knowledge when it comes to preventing and mitigating diagnostic error as well as improving the diagnostic process.  Resultingly, the IOM committee concluded that most individuals will experience at least one diagnostic error in their lifetime, at times with devastating consequences. Drs.