The failure to order tests, report results to patients, and follow up with abnormal test findings are leading causes of diagnostic errors, according to a survey of U.S. primary care and specialist physicians. The 6-item survey was completed by nearly 300 physicians from 22 hospitals, who reported 583 cases of diagnostic error-the largest report ever published on diagnostic errors. Gordon Schiff, M.D., of Brigham and Women's Hospital Center for Patient Safety Research and Practice, and colleagues asked physicians to report three cases of diagnostic errors and to describe their perceived causes, seriousness, and frequency.
The most common missed or delayed diagnoses included pulmonary embolism, drug reactions or overdose, lung cancer, colorectal cancer, acute coronary syndrome (including heart attack), breast cancer, and stroke. Diagnostic errors occurred most often in the testing phase (failure to order, report, and follow up laboratory results, 44 percent), followed by clinician assessment errors (failure to consider and overweighing competing diagnoses, 32 percent; inadequate history taking, 10 percent; incomplete physical examination, 10 percent); and referral or consultation errors and delays, 3 percent. Overall, 28 percent of the 583 diagnostic errors were rated as major, resulting in patient death, permanent disability, or a near-life-threatening event. Another 41 percent resulted in moderate adverse outcomes that caused the patient short-term illness, a prolonged hospital stay, an invasive procedure, or more intense care; 31 percent of diagnostic errors were minor or insignificant.
The exact prevalence of diagnostic errors is unknown, and cannot be estimated from the voluntary reporting methodology used in this type of study. However, data from autopsies estimate that diagnostic errors occur in 10 to 15 percent of cases. The study was supported in part by the Agency for Healthcare Research and Quality (HS11552).
More details are in "Diagnostic error in medicine: Analysis of 583 physician-reported errors," by Dr. Schiff, Omar Hasan, M.D., Seijeoung Kim, R.N., Ph.D., and others in the November 9, 2009, issue of the Archives of Internal Medicine 169(20), pp. 1881-1887.