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Joint Commission Issues Alert on Diagnostic Overshadowing

JUNE 2022

The Joint Commission of Oakbrook Terrace, Illinois, issued a new sentinel event alert, “Diagnostic overshadowing among groups experiencing health disparities,” last week. The alert discusses the importance of addressing diagnostic overshadowing—the attribution of symptoms to an existing diagnosis rather than a potential comorbid condition—and provides recommended safety actions, according to a release.

Evidence suggests that diagnostic overshadowing exists within the interactions of clinicians with patients of all ages who have physical disabilities or previous diagnoses such as, but not limited to, autism, mobility disabilities and neurological deficits, as well as patients with conditions or characteristics such as, but not limited to, LGBTQ identifications, history of substance abuse, low health literacy and obesity, according to the release.

“Diagnostic overshadowing is a serious safety and quality concern as an initial misdiagnosis can have a significant impact on quality of life, including the physical and psychological wellness of patients,” said Ana Pujols McKee, MD, executive vice president, chief medical officer, and chief diversity, equity and inclusion officer of The Joint Commission, in the release. “I urge my physician colleagues to recognize that diagnostic overshadowing stems from cognitive bias and work to reduce this through training and education programs. Such bias can have a detrimental effect on future patient workups and how handoffs to other providers are framed.”

The Joint Commission suggests the following actions in the alert.

1. Create an awareness of diagnostic overshadowing during clinical peer and quality assurance reviews and by addressing it in training and education programs.
2. Use listening and interviewing techniques designed to gain better patient engagement and shared decision making.
3. Collect and aggregate data about pre-existing conditions and disabilities and create electronic health record (EHR) prompts for clinicians.
4. Use an intersectional framework when assessing patients in groups prone to diagnostic overshadowing to overcome cognitive biases and look beyond previous diagnoses.
5. Review your organization’s ADA compliance using the added perspective of diagnostic overshadowing to ensure that it meets the needs of patients with physical disabilities.

Additionally, the alert provides a list of related Joint Commission requirements that address disparities and disability issues.

The sentinel event alert is available on The Joint Commission website. It may be reproduced if credited to The Joint Commission.