What’s New in the Patient Safety World
May 2014
Frequency of Diagnostic Errors in Outpatients
A new review shows that over 5% of outpatients have errors in diagnosis, about half of which may be potentially harmful (Singh 2014). The authors estimate that such errors in diagnosis may affect 12 million outpatients annually in the US.
In our March 2013 What’s New in the Patient Safety World column “Diagnostic Error in Primary Care” and our January 2014 What’s New in the Patient Safety World column “Trigger Tools to Prevent Diagnostic Delays” we highlighted previous studies by Singh and colleagues (Singh 2013, Murphy 2014) on diagnostic errors in primary care that used trigger tool methodology. The new study included the previous work and a total of 3 studies using the same definitions and methodologies.
AHRQ, which partially funded the study, did a press release (AHRQ 2014) that also calls attention to the AHRQ toolkit “Improving Your Office Testing Process. A Toolkit for Rapid-Cycle Patient Safety and Quality Improvement” (see our October 2013 What’s New in the Patient Safety World column “New AHRQ Toolkit: Improving Your Office Testing”) and a new set of guides and interactive tools from the ONC to help health care providers more safely use electronic health information technology products, including test results reporting and follow up.
Diagnostic error, and specifically diagnostic error on the outpatient side, is finally receiving the attention it merits. It is important both in its frequent occurrence and the harm that results from it.
Some of our prior columns on diagnostic error:
- September 28, 2010 “Diagnostic Error”
- November 29, 2011 “More
on Diagnostic Error”
- May 15, 2012 “Diagnostic
Error Chapter 3”
- May 29, 2008 “If You Do RCA’s or Design Healthcare Processes…Read Gary Klein’s Work”
- August 12, 2008 “Jerome Groopman’s “How Doctors Think”
- August 10, 2010 “It’s Not Always About The Evidence”
- January 24, 2012 “Patient
Safety in Ambulatory Care”
- October 9, 2012 “Call
for Focus on Diagnostic Errors”
- March 2013 “Diagnostic
Error in Primary Care”
- May 2013 “Scope
and Consequences of Diagnostic Errors”
- August 2013 “Clinical
Intuition”
- January 2014 “Trigger
Tools to Prevent Diagnostic Delays”
- January 14, 2014 “Diagnostic
Error: Salient Distracting Features”
- And our review of Malcolm Gladwell’s “Blink” in our Patient Safety Library
References:
Singh H, Meyer AND, Thomas EJ. The frequency of diagnostic
errors in outpatient care: estimations from three large observational studies
involving US adult populations. BMJ Qual Saf 2014; published online
April 17, 2014
http://qualitysafety.bmj.com/content/early/2014/04/04/bmjqs-2013-002627.short?g=w_qs_ahead_tab
Singh H, Giardina TD, Meyer AND, et al. Types and Origins of Diagnostic Errors in Primary Care Settings. JAMA Intern Med 2013; published online February 25, 2013
http://archinte.jamanetwork.com/article.aspx?articleid=1656540
Murphy DR, Laxmisan A, Reis BA, et al. Electronic health record-based triggers to detect potential delays in cancer diagnosis. BMJ Qual Saf 2014; 23: 8-16 Published Online First: 19 July 201
http://qualitysafety.bmj.com/content/23/1/8.full.pdf+html
AHRQ. Diagnostic Errors Study Findings. Press Release April 16, 2014
http://www.ahrq.gov/news/newsroom/press-releases/2014/diagnostic_errors.html
AHRQ. Improving Your Office Testing Process. A Toolkit for Rapid-Cycle Patient Safety and Quality Improvement. August 2013
ONC (Office of the National Coordinator for Health Information Technology). Safer Guides. HealthIT.gov
http://www.healthit.gov/safer/safer-guides
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