Boston, Massachusetts (PressExposure) December 16, 2009 -- The failure to order tests, report results to patients, or follow-up with abnormal test findings, are leading types of diagnostic errors, according to a survey of primary care and specialist physicians in the United States sponsored by HHS' Agency for Healthcare Research and Quality.
Tests were overlooked because clinicians often failed to consider the diagnosis, leading to delays in ordering the tests or making the correct diagnosis. The most common missed or delayed diagnoses include pulmonary embolism, drug reactions or overdose, lung cancer, colorectal cancer, acute coronary syndrome, including heart attack, breast cancer and stroke, according to the survey which is published in the November 9, 2009 issue of the Archives of Internal Medicine.
The anonymous questionnaire was completed by nearly 300 surveyed physicians who reported 583 cases of diagnosis error -- the largest-ever report of published diagnosis errors. While the exact prevalence of diagnostic errors in unknown, and cannot be estimated from the voluntary reporting methodology used in this type of study, data from autopsies estimate that diagnostic errors occurring 10 to 15 percent of cases.
The study, which was led by Gordon Schiff, M.D., associate director of Brigham and Women's Hospital Center for Patient Safety Research and Practice in Boston, which is part of the Cook County Hospital/Rush University AHRQ-supported Developmental Center for Research in Patient Satiety. According to Dr. Schiff, the survey found that other major categories of errors involved failure to consider a diagnosis or overweighing a competing diagnosis, failures in history taking, physical examination, and referral or consultation delays.
Results further showed that adverse outcomes in 28 percent of the 583 reported cases were major, meaning that they resulted in death, permanent disability, or a near-life-threatening event. Another 41 percent were moderate, causing the patient short-term illness, a prolonged hospital stay, an invasive procedure or more intense care, and 31 percent of the cases were minor or insignificant.
Physicians participating in grand round presentations on diagnostic errors at 20 hospitals across the country were surveyed along with others at two collaborating academic medical centers. The researchers concluded that physicians readily recalled multiple cases of diagnostic errors and were willing to share their experiences, suggesting that soliciting such reports and experiences could be used to enhance knowledge, understanding and awareness of diagnostic errors.
Details are in "Diagnostic Error in Medicine: Analysis of 583 Physician-Reported Errors," in the November 9, 2009 issue of the Archives of Internal Medicine.
SOURCE: Agency for Healthcare Research and Quality