scholarly journals Primary care pediatricians’ interest in diagnostic error reduction

Diagnosis ◽  
2016 ◽  
Vol 3 (2) ◽  
pp. 65-69 ◽  
Author(s):  
Michael L. Rinke ◽  
Hardeep Singh ◽  
Sarah Ruberman ◽  
Jason Adelman ◽  
Steven J. Choi ◽  
...  
Keyword(s):  
Delayed Diagnosis ◽  
Diagnostic Errors ◽  
Diagnostic Error ◽  
Error Reduction ◽  
Self Report ◽  
Abnormal Laboratory ◽  
Electronic Survey ◽  
Laboratory Values ◽  
Life Threatening

Abstract: Diagnostic errors causing harm in children are understudied, resulting in a knowledge gap regarding pediatricians’ interest in reducing their incidence.: Electronic survey of general pediatricians focusing on diagnostic error incidence, errors they were interested in trying to improve, and errors reduced by their electronic health record (EHR).: Of 300 contacted pediatricians, 77 (26%) responded, 58 (19%) served ambulatory patients, and 48 (16%) completed the entire questionnaire. Of these 48, 17 (35%) reported making a diagnostic error at least monthly, and 16 (33%) reported making a diagnostic error resulting in an adverse event at least annually. Pediatricians were “most” interested in “trying to improve” missed diagnosis of hypertension (17%), delayed diagnosis due to missed subspecialty referral (15%), and errors associated with delayed follow-up of abnormal laboratory values (13%). Among the 44 pediatricians with an EHR, 16 (36%) said it reduced the likelihood of missing obesity and 14 (32%) said it reduced the likelihood of missing hypertension. Also, 15 (34%) said it helped avoid delays in follow-up of abnormal laboratory values. A third (36%) reported no help in diagnostic error reduction from their EHR.: Pediatricians self-report an appreciable number of diagnostic errors and were most interested in preventing high frequency, non-life-threatening errors. There exists a need to leverage EHRs to support error reduction efforts.

scholarly journals Errors in Diagnosing Infectious Diseases: A Physician Survey

2021 ◽  
Vol 8 ◽  
Author(s):  
Mahboubeh Haddad ◽  
Fereshte Sheybani ◽  
HamidReza Naderi ◽  
Mohammad Saeed Sasan ◽  
Mona Najaf Najafi ◽  
...  
Keyword(s):  
Infectious Diseases ◽  
Diagnostic Errors ◽  
Diagnostic Error ◽  
Upper Respiratory Tract ◽  
Clinical Syndromes ◽  
Life Threatening ◽  
Diagnostic Hypothesis ◽  
Poor Outcomes ◽  
Tract Infections ◽  
Abdominal Infections

Background: Infectious diseases are commonly missed or misdiagnosed. Errors in diagnosing infectious diseases not only affect the patient but also the community health.Objectives: To describe our investigation on the most common errors in diagnosing infectious diseases and their causes according to the physicians' reports.Methods: Between August 2018 and February 2019, specialist physicians and residents across Mashhad, Iran were invited to participate in a survey to report errors they had made or witnessed regarding the diagnosis of infectious diseases.Results: Overall, 465 cases were reported by 315 participants. The most common infectious diseases affected by diagnostic errors were upper respiratory tract infections (URTIs) (n = 69, 14.8%), tuberculosis (TB) (n = 66, 14.1%), pleuro-pulmonary infections (n = 54, 11.6%), central nervous system (CNS) infections (n = 51, 10.9%), and urinary tract infections (n = 45, 9.6%). Errors occurred most frequently in generating a diagnostic hypothesis (n = 259, 55/7%), followed by history taking (n = 200, 43%), and physical examination (n = 191, 41/1%). Errors related to the diagnosis of TB (odds ratio [OR]: 2.4, 95% confidence interval [CI]:0.9–5.7; P value: 0.047) and intra-abdominal infections (OR: 7.2, 95% CI: 0.9–53.8; P value: 0.02) were associated with more-serious outcomes.Conclusion: A substantial proportion of errors in diagnosing infectious diseases moderately or seriously affect patients' outcomes. URTIs, TB, and pleuropulmonary infections were the most frequently reported infectious diseases involved in diagnostic error while errors related to the diagnosis of TB and intraabdominal infections were more frequently associated with poor outcomes. Therefore, contagious and potentially life-threatening infectious diseases should always be considered in the differential diagnosis of patients who present with compatible clinical syndromes.

Inaccurate or delayed diagnosis of hollow organ perforation by emergency physicians: using a qualitative approach to identify the causes

Diagnosis ◽  
2016 ◽  
Vol 3 (3) ◽  
pp. 115-121
Author(s):  
Chi-Chun Peng ◽  
Chaou-Shune Lin ◽  
Peter Woo ◽  
Henry Chih-Hung Tai ◽  
Cho-Chao Feng
Keyword(s):  
Delayed Diagnosis ◽  
Diagnostic Errors ◽  
Diagnostic Error ◽  
Qualitative Approach ◽  
Diagnostic Process ◽  
Valuable Insight ◽  
Emergency Physicians ◽  
Structured Interviews ◽  
Essential Information ◽  
Hollow Organ

AbstractBackground:Mistakes or delays in the diagnosis of hollow organ perforation may be detrimental to prognosis. Nonetheless, emergency physicians (EPs) are prone to misdiagnosing this condition in specific scenarios. The factors leading to errors in their cognitive processes, however, have received little attention.Methods:Using a qualitative approach, we conducted in-depth semi-structured interviews with EPs in the emergency departments (EDs) of three hospitals in Taiwan. We purposively selected participants to obtain a sample that can contribute essential information about the diagnostic process. Sampling continued until new information was no longer being gathered. All interviews were audio-recorded, transcribed verbatim, and then analyzed by two investigators according to grounded theory.Results:Based on 23 cases from 20 EPs, four themes emerged from the analysis regarding the reasons for diagnostic errors: (1) atypical disease presentations (6/23; 26%), (2) cognitive process of the physicians (21/23; 91%), (3) systemic factors (14/23; 61%), and (4) composite factors (14/23; 61%).Conclusions:These findings provide valuable insight into the factors that contribute to diagnostic error in cases of abdominal hollow organ perforation. The results offer a basis on which to build a framework for teaching physicians how to avoid misdiagnosing hollow organ perforation in the future.

scholarly journals Unpredictable Outcome of Large Traumatic Oesophageal Injury: An Experience and Challenges

2021 ◽  
Author(s):  
Mahaveer Singh Rodha ◽  
Satya Prakash Meena ◽  
Subhash Chandra Soni ◽  
Pawan Kumar Garg ◽  
Althea Vency Cardoz
Keyword(s):  
Traffic Accidents ◽  
Road Traffic ◽  
Thoracoscopic Surgery ◽  
Delayed Diagnosis ◽  
Oesophageal Perforation ◽  
Feeding Jejunostomy ◽  
Oesophageal Injury ◽  
Life Threatening ◽  
Thoracic Oesophagus

Oesophageal injury following blunt or penetrating injury due to road traffic accidents is a rare cause of morbidity and mortality. The outcome of delayed diagnosis of oesophageal injury is mostly life threatening conditions. A 23-year-old female presented with respiratory distress, fever, chest pain and facial deformity, following road traffic accident 15 days back. After evaluation, the patient was diagnosed with septicaemia due to large thoracic oesophageal perforation with left pyothorax. The patient was managed by Video Assisted Thoracoscopic Surgery (VATS) decortication with feeding jejunostomy followed by diversion cervical oesophagostomy. The patient was planned for oesophageal reconstructive surgery electively in follow-up period. After six weeks in the follow-up period, surprisingly large thoracic oesophagus perforation and cervical oesophagostomy was healed spontaneously which was confirmed by gastrograffin study. Spontaneous closure of large thoracic oesophageal perforation is the rare outcome of this injury.

scholarly journals Use of an Expedited Review Tool to Screen for Prior Diagnostic Error in Emergency Department Patients

2015 ◽  
Vol 06 (04) ◽  
pp. 619-628 ◽  
Author(s):  
R. El-Kareh ◽  
G. Schiff ◽  
J. Hudspeth
Keyword(s):  
Emergency Department ◽  
Delayed Diagnosis ◽  
Diagnostic Errors ◽  
Diagnostic Error ◽  
Clinical Encounter ◽  
Care Quality ◽  
Rapid Review ◽  
Emergency Department Patients ◽  
Missed Diagnoses

Summary Objective: Missed diagnoses are an important area of care quality resulting in significant morbidity and mortality. Determination of rates and causes has been limited by difficulties in screening, including the effort of manual chart review. We developed and tested a semi- automated review tool to expedite screening for diagnostic errors in an electronic health record (EHR). Methods: We retrospectively reviewed patients seen in the emergency department (ED) of a teaching hospital over 31 days, using an automated screen to identify those with a prior in-system visit during the 14 days preceding their ED visit. We collected prior and subsequent notes from the institution’s EHR for these cases, then populated a specially designed relational database enabling rapid comparison of prior visit records to the sentinel ED visit. Each case was assessed for potential missed or delayed diagnosis, and rated by likelihood as “definite, probable, possible, unlikely or none.” Results: A total of 5 066 patient encounters were screened by a clinician using the tool, of which 1 498 (30%) had a clinical encounter within the preceding 14 days. Of these, 37 encounters (2.6% of those reviewed) were “definite” or “probable” missed diagnoses. The rapid review tool took a mean of 1.9 minutes per case for primary review, compared with 11.2 minutes per case for reviews without the automated tool. Conclusions: Diagnostic errors were present in a significant number of cases presenting to the ED after recent healthcare visits. An innovative review tool enabled a substantially increased efficiency in screening for diagnostic errors.

scholarly journals Risk Factors for Emergency Department Unscheduled Return Visits

Medicina ◽  
2019 ◽  
Vol 55 (8) ◽  
pp. 457
Author(s):  
Soh ◽  
Lin ◽  
Pan ◽  
Ho ◽  
Mahadevan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Abdominal Pain ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Delayed Diagnosis ◽  
Diagnostic Errors ◽  
Neurological Deficits ◽  
Return Visits

Background and Objectives: This study aims to identify reasons for unscheduled return visits (URVs), and risk factors for diagnostic errors leading to URVs, with comparisons to data from a similar study conducted in the same institution 9 years ago. Materials and Methods: This retrospective study included adult patients who attended the emergency department (ED) of a tertiary hospital in Singapore between January 2014 and June 2014, with re-attendance within 72 h for the same or similar complaint. The primary outcome was wrong or delayed diagnoses. Secondary outcomes include admission to the ED observation unit or ward on return visit. Findings were compared with the previous study performed in 2005 to identify trends. Results: Of 67,422 attendances, there were 1298 (1.93%) URVs from 1207 patients (median age 34, interquartile range 24 to 52 years; 59.7% male). The most common presenting complaint was abdominal pain (22.2%). One hundred ninety-one (15.8%) patients received an initial wrong or delayed diagnosis. Factors (adjusted odds ratio; 95% CI) associated with this were: presenting complaints of abdominal pain (2.99; 2.12–4.23), fever (1.60; 1.1–2.33), neurological deficit (4.26; 1.94–9.35), and discharge without follow-up (1.61; 1.1–2.26). Among re-attendances, 459 (38.0%) required admission. Factors (adjusted odds ratio; 95% CI) associated with admission were: male gender (1.88; 1.42 to 2.48); comorbidities of diabetes mellitus (2.07; 1.29–3.31), asthma (5.23; 1.59–17.26), and renal disease (7.48; 2.00–28.05); presenting complaints of abdominal pain (1.83; 1.32–2.55), fever (3.05; 2.10–4.44), and giddiness or vertigo (2.17; 1.26–3.73). There was a reduction in URV rate compared to the previous study in 2005 (1.93% versus 2.19%). Abdominal pain at the index visit remains a significant cause of URVs (22.2% versus 25.1%). Conclusions: Presenting complaints of neurological deficits, abdominal pain, fever, and discharge without follow-up were associated with wrong or delayed diagnoses among URVs.

scholarly journals Incidence, origins and avoidable harm of missed opportunities in diagnosis: longitudinal patient record review in 21 English general practices

2021 ◽  
pp. bmjqs-2020-012594
Author(s):  
Sudeh Cheraghi-Sohi ◽  
Fiona Holland ◽  
Hardeep Singh ◽  
Avril Danczak ◽  
Aneez Esmail ◽  
...  
Keyword(s):  
Diagnostic Errors ◽  
Diagnostic Error ◽  
Policy Changes ◽  
Missed Opportunities ◽  
Secondary Factor ◽  
General Practices ◽  
Missed Diagnostic Opportunities ◽  
Safety Priority ◽  
Record Review

BackgroundDiagnostic error is a global patient safety priority.ObjectivesTo estimate the incidence, origins and avoidable harm of diagnostic errors in English general practice. Diagnostic errors were defined as missed opportunities to make a correct or timely diagnosis based on the evidence available (missed diagnostic opportunities, MDOs).MethodRetrospective medical record reviews identified MDOs in 21 general practices. In each practice, two trained general practitioner reviewers independently conducted case note reviews on 100 randomly selected adult consultations performed during 2013–2014. Consultations where either reviewer identified an MDO were jointly reviewed.ResultsAcross 2057 unique consultations, reviewers agreed that an MDO was possible, likely or certain in 89 cases or 4.3% (95% CI 3.6% to 5.2%) of reviewed consultations. Inter-reviewer agreement was higher than most comparable studies (Fleiss’ kappa=0.63). Sixty-four MDOs (72%) had two or more contributing process breakdowns. Breakdowns involved problems in the patient–practitioner encounter such as history taking, examination or ordering tests (main or secondary factor in 61 (68%) cases), performance and interpretation of diagnostic tests (31; 35%) and follow-up and tracking of diagnostic information (43; 48%). 37% of MDOs were rated as resulting in moderate to severe avoidable patient harm.ConclusionsAlthough MDOs occurred in fewer than 5% of the investigated consultations, the high numbers of primary care contacts nationally suggest that several million patients are potentially at risk of avoidable harm from MDOs each year. Causes of MDOs were frequently multifactorial, suggesting the need for development and evaluation of multipronged interventions, along with policy changes to support them.

scholarly journals Diagnostic Error - Mini Review and Case Report of Patient Death Resulting from Delayed Diagnosis of Acute Prostatitis

2013 ◽  
Vol 6 (1) ◽  
pp. 31-35 ◽  
Author(s):  
Dragica K. Mrkoci ◽  
Katherine C. Chretien
Keyword(s):  
Health Care Providers ◽  
Delayed Diagnosis ◽  
Diagnostic Errors ◽  
Diagnostic Error ◽  
Care Providers ◽  
Patient Death ◽  
Benign Prostate Hypertrophy ◽  
Intravenous Antibiotics ◽  
Malpractice Claims ◽  
Benign Prostate

A 57-year old man presenting with frequent and painful urination and negative initial urinalysis for infection was given a diagnosis of benign prostate hypertrophy, which was never revised by subsequent providers. Instead, the patient continued to be treated for urinary retention and pain. A potent NSAID, Toradol (ketorolac), was included in his regimen. One day prior to his demise, the patient was diagnosed with prostatic abscess and admitted for treatment with intravenous antibiotics. However the patient died on hospital day one from massive GI bleeding. Autopsy revealed an underlying peptic ulcer. This case shines a light on diagnostic error: missed, wrong, or delayed diagnosis. It also uncovers the multifaceted nature of diagnostic errors and highlights the importance of system- related interventions, in particular, better communication between health care providers. Based on malpractice claims data, diagnostic error is the most frequent and costly of all medical mistakes, yet it remains one of the least studied areas of patient safety. While the field has some barriers to study, many opportunities exist for impact in the field of diagnostic errors

Research Participation Experiences of Informants of Suicide and Control Cases

Crisis ◽  
2010 ◽  
Vol 31 (5) ◽  
pp. 238-246 ◽  
Author(s):  
Paul W. C. Wong ◽  
Wincy S. C. Chan ◽  
Philip S. L. Beh ◽  
Fiona W. S. Yau ◽  
Paul S. F. Yip ◽  
...  
Keyword(s):  
Ethical Issues ◽  
Research Participation ◽  
Self Report ◽  
Initial Contact ◽  
Psychological Autopsy ◽  
Autopsy Study ◽  
The People ◽  
And Control ◽  
The Impact

Background: Ethical issues have been raised about using the psychological autopsy approach in the study of suicide. The impact on informants of control cases who participated in case-control psychological autopsy studies has not been investigated. Aims: (1) To investigate whether informants of suicide cases recruited by two approaches (coroners’ court and public mortuaries) respond differently to the initial contact by the research team. (2) To explore the reactions, reasons for participation, and comments of both the informants of suicide and control cases to psychological autopsy interviews. (3) To investigate the impact of the interviews on informants of suicide cases about a month after the interviews. Methods: A self-report questionnaire was used for the informants of both suicide and control cases. Telephone follow-up interviews were conducted with the informants of suicide cases. Results: The majority of the informants of suicide cases, regardless of the initial route of contact, as well as the control cases were positive about being approached to take part in the study. A minority of informants of suicide and control cases found the experience of talking about their family member to be more upsetting than expected. The telephone follow-up interviews showed that none of the informants of suicide cases reported being distressed by the psychological autopsy interviews. Limitations: The acceptance rate for our original psychological autopsy study was modest. Conclusions: The findings of this study are useful for future participants and researchers in measuring the potential benefits and risks of participating in similar sensitive research. Psychological autopsy interviews may be utilized as an active engagement approach to reach out to the people bereaved by suicide, especially in places where the postvention work is underdeveloped.

Profiles of Psychosocial and Clinical Functioning in Adolescence and Risk for Later Depression

2019 ◽  
Author(s):  
Thomas M Olino ◽  
Daniel Klein ◽  
John Seeley
Keyword(s):  
Psychosocial Functioning ◽  
Adolescent Depression ◽  
Depressive Disorders ◽  
Self Report ◽  
Initial Assessment ◽  
Predictive Utility ◽  
Regression Methods ◽  
History Of ◽  
History Of Depression

Background: Most studies examining predictors of onset of depression focus on variable centered regression methods that focus on effects of multiple predictors. In contrast, person-centered approaches develop profiles of factors and these profiles can be examined as predictors of onset. Here, we developed profiles of adolescent psychosocial and clinical functioning among adolescents without a history of major depression. Methods: Data come from a subsample of participants from the Oregon Adolescent Depression Project who completed self-report measures of functioning in adolescence and completed diagnostic and self-report measures at follow-up assessments up to approximately 15 years after baseline. Results: We identified four profiles of psychosocial and clinical functioning: Thriving; Average Functioning; Externalizing Vulnerability and Family Stress; and Internalizing Vulnerability at the baseline assessment of participants without a history of depression at the initial assessment in mid- adolescence. Classes differed in the likelihood of onset and course of depressive disorders, experience of later anxiety and substance use disorders, and psychosocial functioning in adulthood. Moreover, the predictive utility of these classes was maintained when controlling for multiple other established risk factors for depressive disorders. Conclusions: This work highlights the utility of examining multiple factors simultaneously to understand risk for depression.

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