Researchers find assessing patients and tests can lead to diagnostic errors that cause harm.
Diagnostic errors may be claiming the lives of intensive care patients across the nation, according to a new study.
In 2019, 23% of patients transferred to an intensive care unit or who died in hospital experienced a diagnostic error, “the majority of which were harmful to the patient,” said the original investigation published in JAMA Internal Medicine.
Physicians from the University of California San Francisco and Brigham and Women’s Hospital in Massachusetts were among the lead researchers of the study. Those institutions published accompanying news releases about the findings.
Analyzing electronic health records of 2,428 patients in 29 hospitals across the country, they found 550 patients experienced diagnostic errors, or failures to either accurately explain a patient’s health problem or a failure to communicate that information to the patient.
“We know diagnostic errors are dangerous and hospitals are obviously interested in reducing their frequency, but it’s much harder to do this when we don’t know what’s causing these errors or what their direct impact is on individual patients,” senior author Jeffrey L. Schnipper, MD, MPH, said in a news release. Schnipper works in Brigham’s Division of General Internal Medicine and Primary Care. “We found that diagnostic errors can largely be attributed to either errors in testing, or errors in assessing patients, and this knowledge gives us new opportunities to solve these problems.”
The results are similar to those from the 1990s that found common patient safety errors and catalyzed the patient safety movement, first author Andrew Auerbach, MD, MPH, said in a news release. Auerbach is a professor in UCSF’s Division of Hospital Medicine, and he referred to “To Err Is Human,” a 1999 report by the Institute of Medicine.
“We hope our work provides a similar call to action to academic medical centers, researchers and policymakers,” Auerbach said.
Among the patients who experienced a diagnostic error, 486, or 17%, experienced some form of harm due to the error. Among 1,863 patients who died, diagnostic error contributed to 121 cases, or 6.6%, according to the researchers.
“It appears to be that only a minority of deaths in hospitals are linked to diagnostic errors, but even a single patient death that might have been prevented with a better diagnostic process is one death too many,” Schnipper said.
The researchers found that most errors were attributable to errors in assessing patients, or errors in ordering and interpreting diagnostic tests, the news release said.
“These two parts of the diagnostic process feed directly into each other,” Schnipper said. “If you don’t think of the correct possible diagnosis during your assessment of a patient, you’re not going to order the right tests. And if you order the wrong test or order the right test but misinterpret the result, this will inevitably change how you then assess a patient.”
The findings point to the need for improving clinician training and evaluating physicians workloads. Patients and physicians could benefit from more accurate diagnostic tools and techniques, the researchers said.
Among those tools: artificial intelligence (AI) programs that evaluate patients, select appropriate medical tests, and generally reduce delays in care, the researchers said. They noted “care must be taken to ensure the models are performing correctly without introducing errors or widening health disparities.
“In the end, helping physicians become better diagnosticians means coaching and training physicians, and helping physicians clearly explain diagnoses to patients,” Auerbach said. “I suspect AI will help with many tasks, but we still have work to improve communication between patients and healthcare team members to fully advance the field.”
The study was supported by the Agency for Healthcare Research and Quality (AHRQ) in the U.S. Department of Health and Human Services.