Abstract
Progress in understanding and preventing diagnostic errors has been modest. New approaches are needed to help clinicians anticipate and prevent such errors. Delineating recurring diagnostic pitfalls holds potential for conceptual and practical ways for improvement. To develop the construct and collect examples of "diagnostic pitfalls," defined as clinical situations and scenarios vulnerable to errors that may lead to missed, delayed, or wrong diagnoses. This qualitative study used data from January 1, 2004, to December 31, 2016, from retrospective analysis of diagnosis-related patient safety incident reports, closed malpractice claims, and ambulatory morbidity and mortality conferences, as well as specialty focus groups. Data analyses were conducted between January 1, 2017, and December 31, 2019. From each data source, potential diagnostic error cases were identified, and the following information was extracted: erroneous and correct diagnoses, presenting signs and symptoms, and areas of breakdowns in the diagnostic process (using Diagnosis Error Evaluation and Research and Reliable Diagnosis Challenges taxonomies). From this compilation, examples were collected of disease-specific pitfalls; this list was used to conduct a qualitative analysis of emerging themes to derive a generic taxonomy of diagnostic pitfalls. A total of 836 relevant cases were identified among 4325 patient safety incident reports, 403 closed malpractice claims, 24 ambulatory morbidity and mortality conferences, and 355 focus groups responses. From these, 661 disease-specific diagnostic pitfalls were identified. A qualitative review of these disease-specific pitfalls identified 21 generic diagnostic pitfalls categories, which included mistaking one disease for another disease (eg, aortic dissection is misdiagnosed as acute myocardial infarction), failure to appreciate test result limitations, and atypical disease presentations. Recurring types of pitfalls were identified and collected from diagnostic error cases. Clinicians could benefit from knowledge of both disease-specific and generic cross-cutting pitfalls. Study findings can potentially inform educational and quality improvement efforts to anticipate and prevent future errors.
Highlights
Diagnostic errors are the leading type of medical error reported by patients[1] and a leading cause for malpractice claims.[2,3,4] A study of malpractice claims in primary care in Massachusetts found that more than 70% of primary care claims reside in the diagnostic safety realm, and patients rank diagnostic errors as the leading type of medical error that they have experienced.[5]
A qualitative review of these disease-specific pitfalls identified 21 generic diagnostic pitfalls categories, which included mistaking one disease for another disease, failure to appreciate test result limitations, and atypical disease presentations
Our data sources included 4352 patient safety incident reports, 403 closed malpractice claims, 24 ambulatory morbidity and mortality rounds, and 355 focus group responses collected over 6 sessions among physicians from 6 specialties (Figure 1)
Summary
Diagnostic errors are the leading type of medical error reported by patients[1] and a leading cause for malpractice claims.[2,3,4] A study of malpractice claims in primary care in Massachusetts found that more than 70% of primary care claims reside in the diagnostic safety realm, and patients rank diagnostic errors as the leading type of medical error that they have experienced.[5] In 2015, the. National Academy of Medicine issued a report, Improving Diagnosis in Health Care, highlighting the importance and causes of diagnostic errors and making recommendations for preventing and mitigating such errors.[6] despite increasing appreciation of diagnostic errors as a patient safety issue, progress in understanding and preventing diagnostic errors has been modest.[7] Unlike medication errors, which have been more successfully reduced with system-level and information technology–based interventions, there are no comparable single technical or educational fixes for diagnostic errors.[8,9]
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