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Showing results for tags 'Diagnostic error'.
Found 146 results
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Content ArticleThis interview in the Journal of Quality and Patient Safety highlights the career and motivations of Dr. Gordon Schiff, a leader in patient safety whose has focused his efforts on improving medication safety, diagnostic safety and the role of information technology in enhancing care.
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Content ArticleThe objective of this study, published by Risk Management and Healthcare Policy, was to examine factors impacting the awareness of hospital policies and programs and their impact on the actual disclosure of medical errors.
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Content ArticleDr Donna Prosser joins Dr Danielle Ofri to discuss the history of medical errors and how they have greatly impacted hospitals during this time of COVID-19.
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Content ArticlePoor handoffs, lack of feedback, limited support, and a complex diagnostic process contribute to the thousands of misdiagnosis-related hospital deaths each year. A coalition of more than 40 patient and provider advocacy organisations unveiled a two-year initiative to identify and address diagnostic errors in hospitals, which by some estimates kill as many as 80,000 people each year and are the leading cause of malpractice lawsuits. "Providing an accurate medical diagnosis is complex and involves uncertainty, but it’s obviously essential to effective and timely treatment," said Paul L. Epner, CEO and co-founder of the Society to Improve Diagnosis in Medicine.
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Content Article
The incidence of diagnostic error in medicine (2013)
Patient Safety Learning posted an article in Diagnostic error
A wide variety of research studies suggest that breakdowns in the diagnostic process result in a staggering toll of harm and patient deaths. These include autopsy studies, case reviews, surveys of patient and physicians, voluntary reporting systems, using standardised patients, second reviews, diagnostic testing audits and closed claims reviews. Although these different approaches provide important information and unique insights regarding diagnostic errors, each has limitations and none is well suited to establishing the incidence of diagnostic error in actual practice, or the aggregate rate of error and harm. In this BMJ Quality & Safety article, Mark Graber argues that being able to measure the incidence of diagnostic error is essential to enable research studies on diagnostic error, and to initiate quality improvement projects aimed at reducing the risk of error and harm. Three approaches appear most promising in this regard: (1) using ‘trigger tools’ to identify from electronic health records cases at high risk for diagnostic error; (2) using standardised patients (secret shoppers) to study the rate of error in practice; (3) encouraging both patients and physicians to voluntarily report errors they encounter, and facilitating this process. -
Content ArticleThe great majority of medical diagnoses are made using automatic, efficient cognitive processes, and these diagnoses are correct most of the time. This analytic review from Berner and Graber in The American Journal of Medicine concerns the exceptions: the times when these cognitive processes fail and the final diagnosis is missed or wrong. The authors argue that physicians in general underappreciate the likelihood that their diagnoses are wrong and that this tendency to overconfidence is related to both intrinsic and systemically reinforced factors. They present a comprehensive review of the available literature and current thinking related to these issues. The review covers the incidence and impact of diagnostic error, data on physician overconfidence as a contributing cause of errors, strategies to improve the accuracy of diagnostic decision making, and recommendations for future research.
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Content ArticleDiagnostic error is one of the most important safety problems in health care today, and inflicts the most harm. Major diagnostic errors are found in 10% to 20% of autopsies, suggesting that 40,000 to 80,000 patients die annually in the United States from diagnostic errors. Patient surveys confirm that at least one person in three has firsthand experience with a diagnostic error, and researchers have found that diagnostic errors—not surgical mistakes, or medication overdoses—account for the largest fraction of malpractice claims, the most severe patient harm, and the highest total of penalty payouts.
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Content ArticleErrors in clinical reasoning occur in most cases in which the diagnosis is missed, delayed or wrong. The goal of this review from Graber et al., published in BMJ Quality & Safety was to identify interventions that might reduce the likelihood of these cognitive errors. The authors identified a wide range of possible approaches to reduce cognitive errors in diagnosis. Not all the suggestions have been tested, and of those that have, the evaluations typically involved trainees in artificial settings, making it difficult to extrapolate the results to actual practice. Future progress in this area will require methodological refinements in outcome evaluation and rigorously evaluating interventions already suggested, many of which are well conceptualised and widely endorsed.
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Content ArticleWatts et al. evaluated the effectiveness of audit and communication strategies to reduce diagnostic errors made by clinicians.
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Content ArticleDiagnosis is one of the most important tasks performed by primary care providers. Diagnostic errors can lead to patient harm from wrong or delayed testing or treatment. They have emerged as a global priority in patient safety. This report raises awareness among the World Health Organization (WHO) Member States about strategies that could be implemented to reduce diagnostic errors in primary care. After outlining the approach taken to compile information, it describes the importance of examining diagnostic errors, the most common types of diagnostic errors in primary care, and potential solutions.
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Content ArticleMedical misdiagnosis, in the form of inaccurate, late, and delayed diagnoses, is an ongoing problem in the United States. Not only do these diagnostic errors present an ongoing risk to the health and safety of patients, but they also cost the economy billions of dollars. This paper from Pinnacle Care summarises the key research findings on the frequency, human cost, and financial impact of these diagnostic errors, while providing new data on the value of second opinions. An extensive Institute of Medicine (IOM) report underscores the importance of this with its conclusion that most Americans will receive an inaccurate or late diagnosis at least once in their lives, often with life-threatening consequences.
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Content Article
PSNet: Diagnostic errors (September 2019)
Patient Safety Learning posted an article in Diagnostic error
The past decade's quest to improve patient safety has chiefly addressed quantifiable problems such as medication errors, health care–associated infections and postsurgical complications. Diagnostic error has received comparatively less attention, despite the fact that landmark patient safety studies have consistently found that diagnostic error is common. In the Harvard Medical Practice Study, diagnostic error accounted for 17% of preventable errors in hospitalized patients, and a systematic review of autopsy studies covering four decades found that approximately 9% of patients experienced a major diagnostic error that went undetected while the patient was alive. Taken together, these studies imply that thousands of hospitalised patients die every year due to diagnostic errors. This Patient Safety Network (PSNet) explores prevention of diagnostic errors. -
Content ArticleIn September 2015, the Institute of Medicine (IOM) issued the report “Improving Diagnosis in Health Care,” which focused on the underappreciated problem of diagnostic error in medicine. This report builds on the IOM’s 2000 landmark report, “To Err is Human”, which specifically highlighted opportunities for improvement in diagnostically focused fields, such as radiology and pathology. One of the major recommendations of the report is that “health care organizations should adopt policies and practices that promote a nonpunitive culture that values open discussion and feedback on diagnostic performance”. Notably, the report emphasises the ineffectiveness of traditional approaches to evaluating medical error that focus on identifying individuals’ errors. In this article published in Radiology, Larson and colleagues review the recommendations set forth by the recent IOM report, discuss the science and theory that underlie several of those recommendations, and assess how well they fit with the current dominant approach to peer review. They also offer an alternative approach to peer review: peer feedback, learning, and improvement (or more succinctly, “peer learning”), which they believe is better aligned with the principles promoted by the IOM.
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Content Article
Diagnostic error in health care (2015)
Patient Safety Learning posted an article in Diagnostic error
This study is a continuation of the IOM Quality Chasm Series, which focuses on assessing and improving the quality and safety of healthcare. The charge to the committee was to synthesise what is known about diagnostic error as a quality of care challenge and to propose recommendations for improving diagnosis. According to the report, diagnostic errors—inaccurate or delayed diagnoses—persist throughout all settings of care and continue to harm an unacceptable number of patients. The committee concluded that improving the diagnostic process is not only possible, but also represents a moral, professional, and public health imperative. -
Content ArticleThis study, published in Patient Education and Counseling, seeks to gain understanding of breast cancer care providers’ attitudes regarding communicating with patients about diagnostic errors, to inform interventions to improve patient-provider discussions.
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Content ArticleFollowing the release of an Institute of Medicine (IOM) report in 2015 on diagnostic errors, Hardeep Singh, Chief Health Policy, Quality and Informatics Program at the Veterans Affairs Center, gives his perspective to PSNet on this challenging topic.
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Content ArticleDiagnostic errors have recently been identified as a high-priority patient safety problem in primary care by the World Health Organization (WHO). However, no studies exist in UK to quantify the extent of such errors and associated harm in primary care. This oral presentation from Sudeh Cheraghi-Sohi et al. published in the British Journal of General Practice aimed to determine the incidence of ‘missed diagnostic opportunities’ in UK primary care.
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Content ArticleAs the death toll from COVID-19 rapidly increases, the need to make a timely and accurate diagnosis has never been greater. Even before the pandemic, diagnostic errors (i.e., missed, delayed, and incorrect diagnoses) had been one of the leading contributors to harm in health care. The COVID-19 pandemic is likely to increase the risk of such errors. Based on emerging literature and collaborative discussions across the globe, Gandhi and Singh propose a new typology of diagnostic errors of concern in the COVID-19 era. These errors span the entire continuum of care and have both systems-based and cognitive origins. While some errors arise from previously described clinical reasoning fallacies, others are unique to the pandemic. We provide a user-friendly nomenclature while describing eight types of diagnostic errors and highlight mitigation strategies to reduce potential preventable harm caused by those errors.
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Content ArticleIn this blog for the Citizens Commission on Human Rights, Jane London shares her account of how electroconvulsive therapy (ECT) has affected her life since early adulthood, resulting in severe memory loss and heart problems. Jane shares how her physical medical problems including appendicitis and a severe heart attack were put down to depression, and how she was nearly forced to have ECT against her will in England in 1966. When her abusive marriage ended in 1968 and Jane returned to Australia her mother insisted she have ECT, despite her depression being temporary and related to her marriage ending. After 14 treatments, Jane left the treatment facility and received talking therapy to help her recover. Jane talks about the dramatic adverse effect ECT has had on the rest of her adult life.
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Content ArticleThis study in JAMA Network Open aimed to investigate whether attention-deficit/hyperactivity disorder (ADHD) is over diagnosed in children and adolescents. The authors reviewed 334 published studies and found convincing evidence that ADHD is over diagnosed. They highlight that the harms associated with ADHD diagnosis may outweigh the benefits, particularly in children and young people with milder symptoms.
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Content ArticleThis blog describes the experience of Colonel Steven Coffee, Cofounder of Patients for Patient Safety US, who experienced a series of medical errors following the birth of his son. After a missed diagnosis of galactosemia, his son suffered liver failure and underwent a liver transplant at eight weeks old. Following his operation, the hospital where he was being treated did not have access to the powdered soy milk which was essential for his son's recovery. This experience spurred Colonel Coffee on to become an advocate for patient quality and safety in health care. For the last nine years, he has worked toward improved patient safety as the first community chair of MedStar Health’s Patient and Family Advisory Council for Quality and Safety (PFACQ).
