Diagnostic errors could be adversely affecting 1 in every 14 patients who are receiving general medical care in American hospitals, according to a study recently published in BMJ Quality & Safety.
Diagnostic errors can happen when a medical condition is not correctly identified or detected in time. These types of mistakes can lead to serious consequences such as the wrong treatment or delays in the correct treatment which in turn lead to poor outcomes.
Investigating diagnostic errors
This study focused on diagnostic errors that caused harm to patients and explored how these errors may be prevented. The researchers found that the vast majority of the diagnostic errors were preventable, revealing the urgent need for better surveillance methods to identify and prevent errors before they can cause harm.
“The majority of [the diagnostic errors] were preventable,” a team led by Dr. Anuj Dalal of Brigham and Women’s Hospital in Boston concluded in the study. Dalal is also an instructor in internal medicine at Harvard Medical School.
Developing a new method
The researchers developed a new method to review patient records and look for signs of diagnostic errors. This method was used to examine the medical records of 675 randomly selected hospital patients from 9147 eligible cases who received general medical care between July 2019 and September 2021, excluding those who were admitted during the height of the COVID-19 pandemic.
Patients were categorized into either low or high-risk groups based on various factors such as whether they were transferred to intensive care, had complex medical issues, had died within 90 days of admission, and none of the aforementioned high-risk criteria. (Complex issues included clinical deteriorations, unclear test results, and treatment by multiple medical teams)
Identifying errors
Out of all the cases reviewed, 160 cases were found to have diagnostic errors. The researchers identified 84 cases in which diagnostic errors caused damage to patients, with these errors most often occurring in patients requiring intensive care, or in those who died within 90 days of admission.
Severity of harm caused
The severity of harm caused by diagnostic errors varied, with 6% of the errors causing minor harm, 43% causing moderate harm, 30% causing major harm, and 21.5% causing fatal harm to the patients. The researchers estimated that 85% of these harmful diagnostic errors could have been avoided had better processes been in place.
Groups more likely to experience diagnostic errors
Certain groups of patients were more likely to experience diagnostic errors, including older, non-privately insured, white, non-Hispanic, and high-risk patients. The most common conditions that were found to be involved in diagnostic errors included sepsis, pneumonia, abdominal pain, respiratory failure, heart failure, and acute kidney failure.
Specific causes of errors
Specific causes of diagnostic errors were also identified such as patient concerns being overlooked, uncertainty in initial assessments, miscommunication between medical teams, and problems with diagnostic testing. Additionally, delays in diagnosis were also common (61.9%).
Widespread problem
The researchers noted that while this study was conducted at a single medical center, the results point towards a widespread problem with diagnostic errors and concluded that new surveillance approaches are urgently needed to prevent these kinds of mistakes from happening and continuing to harm patients, causing preventable poor health outcomes.
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References/Sources/Materials provided by:
https://qualitysafety.bmj.com/content/early/2024/09/18/bmjqs-2024-017183
https://worldhealth.net/news/americans-pay-most-for-worst-health-outcomes/