Volume 37 Number 4 | August 2023
Patient Safety Corner
Katrina Moreau, MPH, MAT, MLS(ASCP)CM, ASCLS Patient Safety Committee
What do an individual’s genetics and behaviors, places of residence and employment, education quality and access, healthcare quality and access, and social context all have in common? They are all nonmedical factors, also known as social determinants of health (SDOH), which exist in our communities and influence a person’s health outcomes. Understanding the complex relationship between SDOH, patient safety, and diagnosis is essential for improving healthcare delivery and reducing health disparities in our communities. This article explores a few examples of the intersectionality of SDOH and patient safety regarding diagnosis and discusses potential strategies to address the challenges.
Some medical laboratories are in small hospitals; others are part of larger health networks. They may be in rural counties or could be robust reference laboratories in urban areas. The employees range from generalists to highly specialized, and administrators to technical experts. The differences within “internal” laboratory communities are valuable. Every individual has a unique perspective and is also a consumer of diagnostic services. To best serve our patients, it is important to consider which internal practices are potentially contributing to disparities in care, such as the existence of race-based algorithms and utilization of reference ranges not inclusive of the population served. By advocating for changes based on new best practices, the laboratory can do its part to reduce disparities.
“Identifying practices which exacerbate health disparities, being advocates for the communities served, giving community members a voice, and considering the quality of the data utilized in innovative tools are proactive measures to ensure patient safety.”
Diagnostic accuracy is something that laboratorians pride themselves on due to the enormous effort to provide the right result, for the right test, to the right patient, at the right time. However, SDOH may impact diagnostic accuracy due to the influence of low health literacy and language barriers on the ability of patients to accurately describe their symptoms1. Personal and professional biases, cultural differences, and atypical presentations may also lead to misdiagnosis or diagnostic errors. As a laboratory community, it is essential to maintain awareness of these influences throughout the diagnostic process. Engaging in continuing education activities related to the SDOH provides an opportunity to be in discussions on how internal systems can be improved to maintain our diagnostic centers of excellence.
Lastly, technology and innovation not only improve patient safety by reducing inefficiencies across the laboratory, it also can aid in addressing challenges with SDOH. From telemedicine to mobile health clinics, underserved populations within our communities can have better access to care and laboratory services. Tools such as artificial intelligence (AI) have been shown to potentially improve patient safety by reduction of diagnostic errors in radiology2, and in the digital health space, it is being used to predict risk of health outcomes based on SDOH. However, AI in the clinical environment utilizes electronic health record data, and, therefore, errors in records have the potential to lead to patient harm. It is imperative to ensure accurate records and consider the trust of the community in AI prior to implementing such tools.
In summary, there are several things we can do from within the medical laboratory profession to improve the safety of patients in our communities by addressing the challenges of social determinants on health outcomes. Identifying practices which exacerbate health disparities, being advocates for the communities served, giving community members a voice, and considering the quality of the data utilized in innovative tools are proactive measures to ensure patient safety. Communities require collaboration, and while we do our part in the clinical environment, we must ensure that we are considering the social determinants.
References
- Benda, Natalie C. PhD∗,†; Wesley, Deliya B. PhD, MPHD∗,‡; Nare, Matthew MS§; Fong, Allan MS∗; Ratwani, Raj M. PhD∗; Kellogg, Kathryn M. MD, MPH∗,¶. Social Determinants of Health and Patient Safety: An Analysis of Patient Safety Event Reports Related to Limited English-Proficient Patients. Journal of Patient Safety 18(1):p e1-e9, January 2022.
- Challen R, Denny J, Pitt M, et al. Artificial intelligence, bias and clinical safety. BMJ Quality & Safety 2019;28:231-237.
Katrina Moreau (she/her) is a Clinical Associate Professor at the University of Vermont and Director of the undergraduate Medical Laboratory Sciences Program. Outside of academia, Kate serves as the Laboratory Consultant and CLIA Director for the Community Health Centers (FQHC). Her areas of interest are workforce development, community partnerships, point-of-care testing, and population health.