Errors mainly due to patient-doc encounter breakdowns; potential for moderate, severe harm
TUESDAY, Feb. 26 (HealthDay News) -- Diagnostic errors are seen in a variety of common conditions and most often relate to process breakdowns in patient-practitioner clinical encounters, according to research published online Feb. 25 in JAMA Internal Medicine.
Hardeep Singh, M.D., M.P.H., from the Houston VA Health Services Research and Development Center of Excellence, and colleagues reviewed medical records of diagnostic errors detected at two sites through electronic health record-based triggers to assess the types of diseases missed and diagnostic processes involved in 190 cases of confirmed diagnostic errors.
The researchers found that 68 unique diagnoses were missed in the 190 cases. The missed diagnoses were primarily common conditions in primary care, including pneumonia (6.7 percent), decompensated congestive heart failure (5.7 percent), acute renal failure (5.3 percent), cancer (5.3 percent), and urinary tract infection or pyelonephritis (4.8 percent). Most errors were related to process breakdowns in the patient-practitioner clinical encounters (78.9 percent), mainly due to problems in history taking, examination, and/or ordering diagnostic work-up. Errors were also related to process breakdowns in referrals, patient-related factors, follow-up and tracking of diagnostic information, and performance and interpretation of diagnostic tests, with nearly half of cases (43.7 percent) involving more than one process. Most errors had the potential for moderate-to-severe harm.
"Diagnostic errors in primary care include a heterogeneous group of common conditions, and most have potential to lead to moderate-to-severe harm," the authors write. "Preventive interventions must focus on common contributory factors, particularly those that influence the effectiveness of data gathering and synthesis in the patient-practitioner encounter."
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