USA: Data analysis reveals common errors that prevent patients from getting timely, accurate diagnoses

A new data analysis from ECRI, a global patient safety nonprofit, found that issues processing medical tests, delays in referrals, and miscommunication among healthcare staff are key drivers of diagnostic errors.

ECRI's data analysis found that most errors (nearly 70%) occurred during the testing process – including when healthcare staff are ordering, collecting, processing, obtaining results, or communicating results. Twelve percent of errors occurred in the monitoring and follow-up phase; with nearly nine percent during the referral and consultation phase.

Of errors that occurred during testing, more than 23% were a result of a technical or processing error, like the misuse of testing equipment, a poorly processed specimen, or a clinician lacking the proper skill to conduct the test. Another 20 percent of testing errors were a result of mixed-up samples, mislabeled specimens, and tests performed on the wrong patient.

“It’s a common misconception that if a patient has a missed or incorrect diagnosis, their doctor came up with the wrong hypothesis after having all the facts,” said ECRI President and CEO Marcus Schabacker. “That does happen occasionally, but we found that was tied to less than 3 percent of diagnostic errors. What’s more likely to break the diagnostic process are technical, administrative and communication-related issues. These represent system failures, where many small mistakes lead to one big mistake.” 

Many factors can cause diagnostic errors, including miscommunication among providers; miscommunication between providers and patients; and systemic factors like productivity pressures that prevent providers from exploring all investigative options or from consulting other providers. In some of the cases ECRI analysed, test results were not reviewed quickly enough by the provider who ordered them, or results were never communicated to the patient themselves. Referrals to specialists or requests for additional consultations can complicate the process, presenting more potential failure points.

Although any patient can experience diagnostic error, women and racial and ethnic minorities are at greater risk, with one study pointing to a 20 to 30% increase in the likelihood they are misdiagnosed. This is due to many factors, including providers’ explicit or implicit biases; race-based biases in medical algorithms; barriers to care and insurance access; and communication barriers.

Although most of the diagnostic process is out of the patients’ control, Schabacker shared tips for patients seeking to improve the likelihood they get a prompt and accurate diagnosis.

“It is important patients ask questions to understand why their doctor is ordering tests, and are those tests urgent,” said Schabacker. “Schedule your appointments and tests quickly and follow up with your provider if you’re awaiting results. If possible, ask a family member or friend to join you in important appointments, to help ask questions and take notes.”

ECRI’s report identifies strategies healthcare organisations can execute to improve diagnostic safety, centred on the total systems safety approach and human-factors engineering.

“The problem of diagnostic safety comes down to the lack of a systems-based approach. Since there are multiple potential failure points, a single intervention is insufficient,” warned Schabacker.

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Source: ECRI, 5 September 2024

World Patient Safety Day, organised by the World Health Organization (WHO), takes place on Tuesday 17 September 2024. The theme of this year’s event is ‘Improving diagnosis for patient safety’. Leading up to the day we will be publishing case studies, opinion pieces and patient experiences focused on diagnostic safety. Find out more here.