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

Ways that nurse practitioner students self-explain during diagnostic reasoning

Diagnosis ◽  
2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Leah Burt ◽  
Susan Corbridge ◽  
Colleen Corte ◽  
Laurie Quinn ◽  
Lorna Finnegan ◽  
...  
Keyword(s):  
Problem Solving ◽  
Health Care Providers ◽  
Nurse Practitioner ◽  
Descriptive Analysis ◽  
Diagnostic Errors ◽  
Diagnostic Reasoning ◽  
Knowledge Structures ◽  
Future Research ◽  
Biological Knowledge ◽  
Care Providers

Abstract Objectives An important step in mitigating the burden of diagnostic errors is strengthening diagnostic reasoning among health care providers. A promising way forward is through self-explanation, the purposeful technique of generating self-directed explanations to process novel information while problem-solving. Self-explanation actively improves knowledge structures within learners’ memories, facilitating problem-solving accuracy and acquisition of knowledge. When students self-explain, they make sense of information in a variety of unique ways, ranging from simple restatements to multidimensional thoughts. Successful problem-solvers frequently use specific, high-quality self-explanation types. The unique types of self-explanation present among nurse practitioner (NP) student diagnosticians have yet to be explored. This study explores the question: How do NP students self-explain during diagnostic reasoning? Methods Thirty-seven Family NP students enrolled in the Doctor of Nursing Practice program at a large, Midwestern U.S. university diagnosed three written case studies while self-explaining. Dual methodology content analyses facilitated both deductive and qualitative descriptive analysis. Results Categories emerged describing the unique ways that NP student diagnosticians self-explain. Nine categories of inference self-explanations included clinical and biological foci. Eight categories of non-inference self-explanations monitored students’ understanding of clinical data and reflect shallow information processing. Conclusions Findings extend the understanding of self-explanation use during diagnostic reasoning by affording a glimpse into fine-grained knowledge structures of NP students. NP students apply both clinical and biological knowledge, actively improving immature knowledge structures. Future research should examine relationships between categories of self-explanation and markers of diagnostic success, a step in developing prompted self-explanation learning interventions.

scholarly journals Use of patient complaints to identify diagnosis-related safety concerns: a mixed-method evaluation

2021 ◽  
pp. bmjqs-2020-011593
Author(s):  
Traber D Giardina ◽  
Saritha Korukonda ◽  
Umber Shahid ◽  
Viralkumar Vaghani ◽  
Divvy K Upadhyay ◽  
...  
Keyword(s):  
Medical Record ◽  
Clinical Care ◽  
Diagnostic Testing ◽  
Diagnostic Errors ◽  
Diagnostic Error ◽  
Diagnostic Process ◽  
Healthcare Organisation ◽  
Safety Concerns ◽  
Patient Complaints ◽  
Malpractice Claims

BackgroundPatient complaints are associated with adverse events and malpractice claims but underused in patient safety improvement.ObjectiveTo systematically evaluate the use of patient complaint data to identify safety concerns related to diagnosis as an initial step to using this information to facilitate learning and improvement.MethodsWe reviewed patient complaints submitted to Geisinger, a large healthcare organisation in the USA, from August to December 2017 (cohort 1) and January to June 2018 (cohort 2). We selected complaints more likely to be associated with diagnostic concerns in Geisinger’s existing complaint taxonomy. Investigators reviewed all complaint summaries and identified cases as ‘concerning’ for diagnostic error using the National Academy of Medicine’s definition of diagnostic error. For all ‘concerning’ cases, a clinician-reviewer evaluated the associated investigation report and the patient’s medical record to identify any missed opportunities in making a correct or timely diagnosis. In cohort 2, we selected a 10% sample of ‘concerning’ cases to test this smaller pragmatic sample as a proof of concept for future organisational monitoring.ResultsIn cohort 1, we reviewed 1865 complaint summaries and identified 177 (9.5%) concerning reports. Review and analysis identified 39 diagnostic errors. Most were categorised as ‘Clinical Care issues’ (27, 69.2%), defined as concerns/questions related to the care that is provided by clinicians in any setting. In cohort 2, we reviewed 2423 patient complaint summaries and identified 310 (12.8%) concerning reports. The 10% sample (n=31 cases) contained five diagnostic errors. Qualitative analysis of cohort 1 cases identified concerns about return visits for persistent and/or worsening symptoms, interpersonal issues and diagnostic testing.ConclusionsAnalysis of patient complaint data and corresponding medical record review identifies patterns of failures in the diagnostic process reported by patients and families. Health systems could systematically analyse available data on patient complaints to monitor diagnostic safety concerns and identify opportunities for learning and improvement.

scholarly journals Common variable immunodeficiency disorder associated with bronchiectasis: a case report

2021 ◽  
Vol 8 (3) ◽  
pp. 565
Author(s):  
Mohammad Zahirul Islam Khan ◽  
Kamrul Laila ◽  
Mohammed Mahbubul Islam ◽  
Mohammad Imnul Islam ◽  
Shahana Akhter Rahman
Keyword(s):  
Health Care Providers ◽  
Common Variable Immunodeficiency ◽  
Delayed Diagnosis ◽  
Gene Mutations ◽  
Growth Failure ◽  
Recurrent Infections ◽  
Care Providers ◽  
Immunodeficiency Disorder ◽  
Specific Antibody Production ◽  
Common Variable

Common variable immunodeficiency disorder (CVID) is the commonest type of primary immunodeficiency disorders (PIDs) characterized by hypogammaglobulinemia, defective specific antibody production and increased susceptibility of recurrent infections. Autoimmunity, neoplasm and lymphoproliferative disorders are usually associated with CVID. In most cases, the cause is unknown, but multiple gene mutations (10%) may be associated with CVID. Here, we report an eight years old girl with CVID presented with recurrent infections, growth failure, generalized lymphadenopathy and hepatosplenomegaly. Chest examination and radiological findings of this girl were consistent with bronchiectasis. Lack of awareness among health care providers is the reason for delayed diagnosis of several years for this girl. Therefore, it is essential to raise awareness regarding PID patients among the physicians to improve the quality of life.  

Clinical and Autopsy Analysis of Delayed Diagnosis and Missed Injuries in Trauma Patients

2006 ◽  
Vol 72 (2) ◽  
pp. 174-179
Author(s):  
Om P. Sharma ◽  
Diane M. Scala-Barnett ◽  
Michael F. Oswanski ◽  
Amy Aton ◽  
Shekhar S. Raj
Keyword(s):  
Health Care Providers ◽  
Negative Impact ◽  
Delayed Diagnosis ◽  
P Value ◽  
Care Providers ◽  
Missed Injuries ◽  
Impact On Survival ◽  
Group 2 ◽  
Trauma Deaths ◽  
Group 1

Delayed diagnosis of injury (DDI) during hospitalization and missed injuries (MI) on autopsy in trauma deaths result in untoward outcomes. Autopsy is an effective educational tool for health care providers to evaluate trauma care. A retrospective study of trauma registry patients and coroner's records was categorized into groups 1 (alive patients) and 2 (trauma deaths) and analyzed. DDI incidence was similar in group 1 (1.8%) and group 2 (1.9%). Autopsy analysis (163 patients) yielded 139 MI in 94 patients (57.6%), <3 per cent of MI had negative impact on survival. Bony injuries comprised 68 per cent of DDI and 19 per cent of MI. Group 1 DDI patients were sicker with higher injury severity score (ISS: 16.07) than their cohorts (ISS 7.13, P value <0.05). These patients had higher Glasgow Coma Scale (14.41) and lower ISS (16.07) as compared with group 2 MI patients (ISS: 33.49, GCS: 6.45, P value <0.05). Autopsy rate was 99.5 per cent in trauma deaths, 57 per cent for nontrauma deaths, and 79 per cent for all deaths. Less than 3 per cent of MI had negative impact on survival. Routine ongoing patient assessment with pertinent diagnostic workup is essential in reducing DDI. Trauma autopsies reveal MI, which aid performance improvement (PI).

scholarly journals Serious misdiagnosis-related harms in malpractice claims: The “Big Three” – vascular events, infections, and cancers

Diagnosis ◽  
2019 ◽  
Vol 6 (3) ◽  
pp. 227-240 ◽  
Author(s):  
David E. Newman-Toker ◽  
Adam C. Schaffer ◽  
C. Winnie Yu-Moe ◽  
Najlla Nassery ◽  
Ali S. Saber Tehrani ◽  
...  
Keyword(s):  
Diagnostic Errors ◽  
Diagnostic Error ◽  
Healthcare Research ◽  
Insurance Company ◽  
Vascular Events ◽  
Cross Sectional ◽  
Permanent Disability ◽  
High Severity ◽  
Malpractice Claims ◽  
Severity Of Injury

Abstract Background Diagnostic errors cause substantial preventable harm, but national estimates vary widely from 40,000 to 4 million annually. This cross-sectional analysis of a large medical malpractice claims database was the first phase of a three-phase project to estimate the US burden of serious misdiagnosis-related harms. Methods We sought to identify diseases accounting for the majority of serious misdiagnosis-related harms (morbidity/mortality). Diagnostic error cases were identified from Controlled Risk Insurance Company (CRICO)’s Comparative Benchmarking System (CBS) database (2006–2015), representing 28.7% of all US malpractice claims. Diseases were grouped according to the Agency for Healthcare Research and Quality (AHRQ) Clinical Classifications Software (CCS) that aggregates the International Classification of Diseases diagnostic codes into clinically sensible groupings. We analyzed vascular events, infections, and cancers (the “Big Three”), including frequency, severity, and settings. High-severity (serious) harms were defined by scores of 6–9 (serious, permanent disability, or death) on the National Association of Insurance Commissioners (NAIC) Severity of Injury Scale. Results From 55,377 closed claims, we analyzed 11,592 diagnostic error cases [median age 49, interquartile range (IQR) 36–60; 51.7% female]. These included 7379 with high-severity harms (53.0% death). The Big Three diseases accounted for 74.1% of high-severity cases (vascular events 22.8%, infections 13.5%, and cancers 37.8%). In aggregate, the top five from each category (n = 15 diseases) accounted for 47.1% of high-severity cases. The most frequent disease in each category, respectively, was stroke, sepsis, and lung cancer. Causes were disproportionately clinical judgment factors (85.7%) across categories (range 82.0–88.8%). Conclusions The Big Three diseases account for about three-fourths of serious misdiagnosis-related harms. Initial efforts to improve diagnosis should focus on vascular events, infections, and cancers.

scholarly journals Expert Perspectives on Hereditary Angioedema: Key Areas for Advancements in Care across the Patient Journey

2016 ◽  
Vol 7 (3) ◽  
pp. ar.2016.7.0165 ◽  
Author(s):  
Aleena Banerji ◽  
Murat Baş ◽  
Jonathan A. Bernstein ◽  
Isabelle Boccon-Gibod ◽  
Maria Bova ◽  
...  
Keyword(s):  
Health Care Providers ◽  
Hereditary Angioedema ◽  
Delayed Diagnosis ◽  
Scientific Data ◽  
Online Information ◽  
Care Providers ◽  
C1 Inhibitor Deficiency ◽  
Patient Journey ◽  
Diagnosis And Management ◽  
Awareness Campaigns

Background Published literature documents the substantial burden of hereditary angioedema (HAE) with C1 inhibitor deficiency on the quality of life and work productivity of patients. However, despite advances in the field and the availability of guidelines to advise health care providers (HCP) on the diagnosis and management of HAE, there are still many challenges to overcome. For example, delayed diagnosis and misdiagnosis are common, and treatment practices vary worldwide. Objective An international expert panel was convened to consider opportunities for improvements that would benefit patients with HAE. Methods Based on professional and personal experiences, the experts developed schematics to describe the journey of patients through the following stages: (1) onset of symptoms and initial evaluation; (2) referral/diagnosis; and (3) management of HAE. More importantly, the panel identified key areas in which it was possible to optimize the support provided to patients and HCPs along this journey. Results Overall, this approach highlighted the need for wider dissemination of algorithms and scientific data to more effectively educate HCPs from multiple disciplines and the need for more research to inform appropriate treatment decisions. Furthermore, HAE awareness campaigns, accurate online information, and referral to patient advocacy groups were all considered helpful approaches to support patients. Conclusion More detailed and widespread information on the diagnosis and management of HAE is needed and may lead to advancements in care throughout the journey of the patient with HAE.

scholarly journals Online public reactions to frequency of diagnostic errors in US outpatient care

Diagnosis ◽  
2016 ◽  
Vol 3 (1) ◽  
pp. 17-22 ◽  
Author(s):  
Traber Davis Giardina ◽  
Urmimala Sarkar ◽  
Gato Gourley ◽  
Varsha Modi ◽  
Ashley N.D. Meyer ◽  
...  
Keyword(s):  
Health Care ◽  
Quality Of Care ◽  
Health Care Providers ◽  
Diagnostic Errors ◽  
News Article ◽  
Care Providers ◽  
Qualitative Researcher ◽  
Related Quality ◽  
The Impact

AbstractDiagnostic errors pose a significant threat to patient safety but little is known about public perceptions of diagnostic errors. A study published inWe searched the World Wide Web for any news article reporting findings from the study. We then gathered all the online comments made in response to the news articles to evaluate public reaction to the newly reported diagnostic error frequency (n=241). Two coders conducted content analyses of the comments and an experienced qualitative researcher resolved differences.Overall, there were few comments made regarding the frequency of diagnostic errors. However, in response to the media coverage, 44 commenters shared personal experiences of diagnostic errors. Additionally, commentary centered on diagnosis-related quality of care as affected by two emergent categories: (1) US health care providers (n=79; 63 commenters) and (2) US health care reform-related policies, most commonly the Affordable Care Act (ACA) and insurance/reimbursement issues (n=62; 47 commenters).The public appears to have substantial concerns about the impact of the ACA and other reform initiatives on the diagnosis-related quality of care. However, policy discussions on diagnostic errors are largely absent from the current national conversation on improving quality and safety. Because outpatient diagnostic errors have emerged as a major safety concern, researchers and policymakers should consider evaluating the effects of policy and practice changes on diagnostic accuracy.

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.

Malpractice claims related to diagnostic errors in the hospital

2017 ◽  
Vol 27 (1) ◽  
pp. 53-60 ◽  
Author(s):  
Ashwin Gupta ◽  
Ashley Snyder ◽  
Allen Kachalia ◽  
Scott Flanders ◽  
Sanjay Saint ◽  
...  
Keyword(s):  
Diagnostic Errors ◽  
Diagnostic Error ◽  
Trend Test ◽  
Inpatient Setting ◽  
Risk Of Death ◽  
Provider Characteristics ◽  
Hospitalised Patients ◽  
Malpractice Claims ◽  
Male Patients ◽  
Paid Claims

BackgroundLittle is known about the incidence or significance of diagnostic error in the inpatient setting. We used a malpractice claims database to examine incidence, predictors and consequences of diagnosis-related paid malpractice claims in hospitalised patients.MethodsThe US National Practitioner Database was used to identify paid malpractice claims occurring between 1 January 1999 and 31 December 2011. Patient and provider characteristics associated with paid claims were analysed using descriptive statistics. Differences between diagnosis-related paid claims and other paid claim types (eg, surgical, anaesthesia, medication) were assessed using Wilcoxon rank-sum and χ2 tests. Multivariable logistic regression was used to identify patient and provider factors associated with diagnosis-related paid claims. Trends for incidence of diagnosis-related paid claims and median annual payment were assessed using the Cochran-Armitage and non-parametric trend test.Results13 682 of 62 966 paid malpractice claims (22%) were diagnosis-related. Compared with other paid claim types, characteristics significantly associated with diagnosis-related paid claims were as follows: male patients, patient aged >50 years, provider aged <50 years and providers in the northeast region. Compared with other paid claim types, diagnosis-related paid claims were associated with 1.83 times more risk of disability (95% CI 1.75 to 1.91; p<0.001) and 2.33 times more risk of death (95% CI 2.23 to 2.43; p<0.001) than minor injury, after adjusting for patient and provider characteristics. Inpatient diagnostic error accounted for $5.7 billion in payments over the study period, and median diagnosis-related payments increased at a rate disproportionate to other types.ConclusionInpatient diagnosis-related malpractice payments are common and more often associated with disability and death than other claim types. Research focused on understanding and mitigating diagnostic errors in hospital settings is necessary.

scholarly journals An Overview of Medical Malpractice Law in the United States Including Legislative and the Health Care Industry’s Responses to Increased Claims

2017 ◽  
Vol 10 (2) ◽  
pp. 139-163
Author(s):  
Thomas Allan Heller
Keyword(s):  
United States ◽  
Health Care ◽  
Health Care Providers ◽  
Medical Malpractice ◽  
Private Insurance ◽  
The United States ◽  
Care Providers ◽  
Malpractice Insurance ◽  
Malpractice Claims ◽  
Medical Malpractice Claims

Medical Malpractice claims are frequently asserted in the United States. At various time and places, an extraordinarily high number of claims and payouts led to what some have called medical malpractice crises. Consequently, in some geographical locations physicians either could not purchase malpractice insurance as carriers withdrew from the market, or, insurance became increasingly expensive and the overall costs associated with the delivery of health care continued to rise. Other undesirable consequences of these crises included a shortage of qualified physicians in certain parts of the country. Many of the states responded to these problems legislatively through a long series of tort reform measures. The health care industry itself has evolved in numerous ways. In particular, many health care providers have turned away from traditional private insurance models to self-insured models such as captives. Further, the industry has continued to consolidate, with fewer, but larger hospitals and clinics, and with an increasing number of physicians employed directly by hospitals and large clinics. The results of all of these changes have had mixed results.

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