17 Apr Medical Diagnostic Errors Occur In About 5% of US Adults
MedicalResearch.com Interview with:
Dr Hardeep Singh MD MPH
Chief of the health policy, quality & informatics program at the Veterans Affairs Center for Innovations in Quality, Effectiveness and Safety, based at the Michael E. DeBakey VA Medical Center in Houston, Texas
Associate professor at Baylor College of Medicine in Houston
MedicalResearch.com: What are the main findings of the study?
Dr Singh: We built estimates of diagnostic error by compiling and analyzing data from three previous studies. These studies evaluated situations such as unexpected return visits and lack of timely follow up and provided researchers with an estimated frequency of diagnostic error. This frequency was then applied to the general adult population. Diagnostic errors, which we defined as missed opportunities to make a correct or timely diagnosis based on available evidence—occur in about 5 percent of adults in the United States.
MedicalResearch.com: Were any of the findings unexpected?
Dr Singh: The findings are consistent with recent data from the general public about diagnostic errors. This study is significant because it is based on a large sample size and is the most robust estimate thus far to address the frequency of diagnostic error in routine outpatient care.
MedicalResearch.com: What should clinicians and patients take away from your report?
Dr Singh: This is also an area of active research and we need much more research and implementation initiatives to tackle this area. Patient empowerment is key but so is better “cognitive support” to physicians, use of effective information technology to help them make better decisions, better follow-up and tracking of patients and their abnormal findings and better policies both at local and national levels to address this problem. These errors are finally getting attention: see:
http://qualitysafety.bmj.com/content/22/10/789.full
We need national/international initiatives to stimulate research, practice change and policy in this area. We need to also ensure that we measure errors rigorously in settings beyond these research studies for which additional work is needed. The Society of Improved Diagnosis in Medicine is spearheading several other initiatives, including the use of toolkits and other educational initiatives in addition.
http://www.improvediagnosis.org/
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Dr Singh: This is also a multifaceted and complex problem where much remains to be studied. One aspect is improving diagnosis in general and another, to reduce diagnostic error rates. If we look at this from the context of improving diagnosis, there appears to be more going on: large tertiary centers offering second opinions, patients with more access to information such as test results, advanced diagnostic technologies, improved information management through electronic health records, teaching clinical problem skills effectively to trainees etc . If you look at it rigorously from an error reduction perspective, the area appears thinner. The Institute of Medicine recently formed a committee to address this issue as well and will be providing recommendations. We outlined more research in this paper:
http://qualitysafety.bmj.com/content/22/Suppl_2/ii52.long
Citation:
The frequency of diagnostic errors in outpatient care: estimations from three large observational studies involving US adult populations
- Hardeep Singh, Ashley N D Meyer, Eric J Thomas. The frequency of diagnostic errors in outpatient care: estimations from three large observational studies involving US adult populations. BMJ Quality & Safety., April 2014
DOI: 10.1136/bmjqs-2013-002627
Last Updated on June 4, 2015 by Marie Benz MD FAAD