Improved diagnoses in three areas could reduce patient mortality, malpractice claims

Improving diagnoses in three areas-cancer, infections and vascular events-would help improve patient mortality rates and reduce malpractice claims, a new study finds. 

The study, published in the journal Diagnosisearlier this month, suggests that a renewed focus on areas most at risk for misdiagnosis could improve patient mortality rates and reduce malpractice claims.

“Across practice settings, missed vascular events, infections and cancers account for most of the morbidity and mortality attributable to diagnostic errors,” the authors write. “Our main goal was to identify the list of top diseases that, when missed, cause serious harms.”

To accomplish that, the researchers analyzed more than 55,000 malpractice claims between 2006 and 2015, and focused on the nearly 12,000 resulted from a misdiagnosis. About half of the claims involved primary care physicians, including internists, family physicians and pediatrics.

The study found that 74 percent of misdiagnoses that resulted in severe patient harm or death were linked to these three areas:

• Cancer: 38 percent

• Vascular events: 23 percent

• Infection: 13 percent

Specifically, these 15 conditions, each falling within one of the categories, were identified as commonly misdiagnosed that led to severe patient harm:

• Stroke

• Myocardial infarction

• Venous thromboembolism

• Aortic aneurysm and dissection

• Arterial thromboembolism

• Sepsis

• Meningitis and encephalitis

• Spinal abscess

• Pneumonia

• Endocarditis

• Lung cancer

• Breast cancer

• Colorectal cancer

• Prostate cancer

• Melanoma

Estimates vary widely on how many misdiagnoses occur that result in serious patient harm or death-anywhere from 40,000 to 4 million cases each year.

The authors write that most misdiagnoses-more than 85%-are a result of clinical judgement failures rather than a communication breakdown or not closing the loop on tests.

In particular, the authors pointed to three specific conditions to address in different care settings that would make a big difference-stroke in the emergency department, sepsis in the hospital and lung cancer in primary care.

“These results suggest that considerable progress could be made toward reducing overall serious misdiagnosis-related harms by improving diagnostic decision-making for a relatively small number of high-risk conditions in just a few clinical settings,” the authors write.