Dr. Huang
Clinical question: How often do diagnostic errors occur among hospitalized patients who die or are transferred to an intensive care unit (ICU), and how often do diagnostic errors contribute to patient harm?
Background: Diagnostic errors have long been known to contribute to adverse events in hospitalized patients; however, few prior studies have rigorously used structured approaches to screen for diagnostic errors.
Study design: Retrospective cohort study
Setting: 29 academic medical centers in the U.S.
Synopsis: A random sample of 2,428 hospitalized adult patients who died or were transferred to an ICU was identified. Records for these patients were each reviewed by two trained clinicians to determine whether a diagnostic error occurred, and if so, whether patient harm occurred. A diagnostic error was defined as a missed opportunity to make a correct or timely diagnosis based on the available evidence. Of these patients, 550 (23.0%; 95% CI, 20.9% to 25.3%) experienced a diagnostic error. 436 patients (17.8%; 95% CI, 15.9% to 19.8%) had errors contributing to temporary or permanent harm or death.
Diagnostic errors were most often associated with problems with assessment (e.g., recognizing complications or revisiting the differential diagnosis) and problems with testing (e.g., choosing the correct test, ordering the test in a timely manner, or correctly interpreting results). Given the high prevalence of diagnostic errors in this cohort, problems with assessment and testing are important targets for future patient safety improvement interventions.
The rate of diagnostic errors reported in this study is likely higher than in the general hospitalized population as the study selected patients who deteriorated—all patients required ICU transfer or died. Another limitation of the study is detection bias, as reviewers were limited to what was documented in the medical record, which likely under-detects errors in thought processes and gaps in team communication.
Bottom line: Diagnostic errors in hospitalized patients who died or were transferred to an ICU occurred commonly and were associated with patient harm.
Citation: Auerbach AD, Lee TM, et al. Diagnostic errors in hospitalized adults who died or were transferred to intensive care. JAMA Int Med 2024;184(2):164-73.
Dr. Huang is a hospitalist and physician advisor in the division of hospital medicine and a clinical professor of medicine at the University of California in San Diego.