A study published on January 8, 2024 in JAMA Network entitled Diagnostic Errors in Hospitalized Adults Who Died or Were Transferred to Intensive Care investigated how often diagnostic errors happen in adult patients who are transferred to the intensive care unit (ICU) or die in the hospital, what causes the errors, and what are the associated harms.
The researchers conducted a retrospective cohort study at 29 academic medical centers in the United States in a random sample of adults hospitalized with general medical conditions and who were transferred to an ICU, died, or both, from January 1, 2019 to December 31, 2019. The initial cohort was 487, 532 patients admitted to participating sites within the selected period, and who had a medical diagnosis as defined by the Centers for Medicare & Medicaid Services. Of those, 24, 591 (5.0%) died or were transferred to the ICU during their hospitalization. Additional screening yielded 2,997 eligible cases, which were reviewed until 100 medical records were adjudicated at each site or the data collection period was completed. After exclusions and reviews were complete, the final cohort included 2,428 patients – 45.6% female and 54.4% male.
The analysis found that of the 2,428 patient records at 29 hospitals that were reviewed, 550 patients experienced a diagnostic error, representing a mean (SD) error rate of 23.0% (42.1%), which varied fairly widely across sites. Errors were judged to have contributed to temporary harm, permanent harm, or death in 436 patients (among 550 patients with diagnostic error, the error was judged to have contributed to temporary harm, permanent harm, or death in 77.1%). Among all 1,863 patients who died, the diagnostic error was judged to have contributed to death in 121 . Within the group of patients who died and had a diagnostic error, the error contributed to the death in 29.4%.
The most prevalent diagnostic process faults in the cohort were problems with assessment (eg, delay in considering diagnosis, failure to recognize complications, or suboptimal prioritizing of potential diagnoses), access and presentation faults (eg, incorrect triage, failure or delay in seeking care), and problems with testing (eg, delay in ordering or performing needed tests, erroneous clinician interpretation of test). The two diagnostic processes most highly associated with diagnostic error were problems with assessment and testing, corresponding to adjusted proportion attributable fractions of 21.4% and 19.9%, respectively.
The researchers stated, “diagnostic errors were common and associated with patient harm. Problems related to testing, such as choosing the correct test, ordering the test in a timely fashion, or correctly interpreting results, and problems with assessment, such as recognizing complications or revisiting a differential diagnosis, appear to be the most important targets for safety improvement programs.”
The researchers concluded: “In this cohort study of hospitalized patients who died or were transferred to the ICU, diagnostic errors were common, harmful, and associated with factors that can become potential opportunities for interventions. Results from our study provide impetus for rapid exploration and testing of interventions seen to reduce diagnostic errors and harms associated with ICU transfers and deaths by targeting gaps in test selection and interpretation and physicians’ ability to debias and rethink diagnoses as high-priority areas.”
If you or a loved one may have been injured (or worse) as a result of hospital malpractice in the United States, you should promptly find a medical malpractice lawyer in your state who may investigate your hospital medical malpractice claim for you and represent you or your loved one in a hospital medical malpractice case, if appropriate.
Click here to visit our website or call us toll-free in the United States at 800-295-3959 to find hospital medical negligence attorneys in your state who may assist you.
Turn to us when you don’t know where to turn.