Diagnostic Errors in Hospitalized Adults Who Died or Were Transferred to Intensive Care
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Published:2024-01-08
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ISSN:2168-6106
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Container-title:JAMA Internal Medicine
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language:en
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Short-container-title:JAMA Intern Med
Author:
Auerbach Andrew D.1, Lee Tiffany M.1, Hubbard Colin C.1, Ranji Sumant R.2, Raffel Katie3, Valdes Gilmer4, Boscardin John5, Dalal Anuj K.6, Harris Alyssa7, Flynn Ellen7, Schnipper Jeffrey L.6, Feinbloom David8, Roy Bethany N.8, Herzig Shoshana J.8, Wazir Mohammed8, Gershanik Esteban F.8, Goyal Abhishek8, Chitneni Pooja R.8, Burney Sharran8, Galinsky Janice8, Rastegar Sarah8, Moore Danielle8, Berdahl Carl8, Seferian Edward G.8, Suri Krithika8, Ramishvili Tea8, Vedamurthy Deepak8, Hunt Daniel P.8, Mehta Amisha S.8, Katakam Haritha8, Field Stephanie A.8, Karatasakis Barbara8, Beeler Katharina8, Himmel Allison M.8, Eid Shaker8, Gandhi Sonal8, Pena Ivonne M.8, Ranta Zachary S.8, Lipten Samuel D.8, Lucier David J.8, Walker-Corkery Beth8, Kleinman Sween Jennifer8, Kirchoff Robert W.8, Rieck Katie M.8, Kolar Gururaj J.8, Parikh Riddhi S.8, Burton Caroline8, Dugani Chandrasagar8, Dapaah-Afriyie Kwame8, Finn Arkadiy8, Raju Sushma B.8, Surani Asif8, Segon Ankur8, Bhandari Sanjay8, Astik Gopi J.8, O’Leary Kevin J.8, Helminski A. Shams8, Anstey James8, Zhou Mengyu8, Alday Angela E.8, Halvorson Stephanie A.C.8, Esmaili Armond M.8, Barish Peter8, Fenton Cynthia8, Kantor Molly8, Choi Kwang Jin8, Schram Andrew W.8, Ruhnke Gregory8, Patel Hemali8, Virapongse Anunta8, Burden Marisha8, Ngov Li-Kheng8, Keniston Angela8, Talari Preetham8, Romond John B.8, Vick Sarah E.8, Williams Mark V.8, Marr Ruby A.8, Gupta Ashwin B.8, Rohde Jeffrey M.8, Mao Frances8, Fang Michele M.8, Greysen S. Ryan8, Shah Pranav8, Kim Christopher S.8, Narayanan Maya8, Wolpaw Benjamin8, Ellingson Sonja M.8, Kaiksow Farah A.8, Kenik Jordan S.8, Sterken David8, Lewis Michelle E.8, Manwani Bhavish R.8, Ledford Russell W.8, Webber Chase J.8, Vasilevskis Eduard E.8, Buckley Ryan J.8, Kripalani Sunil B.8, Sankey Christopher8, Ostfeld-Johns Sharon R.8, Gielissen Katherine8, Wijesekera Thilan8, Jordan Eric8, Karwa Abhishek8, Churnet Bethlehem8, Chia David8, Brooks Katherine8,
Affiliation:
1. Division of Hospital Medicine, Department of Medicine, University of California San Francisco 2. Division of Hospital Medicine, Zuckerberg San Francisco General Hospital, San Francisco, California 3. Department of Medicine, University of Colorado School of Medicine, Denver 4. Department of Radiation Oncology, University of California San Francisco 5. Division of Geriatrics, Department of Medicine, University of California San Francisco 6. Hospital Medicine Unit, Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, and Harvard Medical School, Boston, Massachusetts 7. Vizient Inc, Irving, Texas 8. for the UPSIDE Research Group
Abstract
ImportanceDiagnostic errors contribute to patient harm, though few data exist to describe their prevalence or underlying causes among medical inpatients.ObjectiveTo determine the prevalence, underlying cause, and harms of diagnostic errors among hospitalized adults transferred to an intensive care unit (ICU) or who died.Design, Setting, and ParticipantsRetrospective cohort study conducted at 29 academic medical centers in the US in a random sample of adults hospitalized with general medical conditions and who were transferred to an ICU, died, or both from January 1 to December 31, 2019. Each record was reviewed by 2 trained clinicians to determine whether a diagnostic error occurred (ie, missed or delayed diagnosis), identify diagnostic process faults, and classify harms. Multivariable models estimated association between process faults and diagnostic error. Opportunity for diagnostic error reduction associated with each fault was estimated using the adjusted proportion attributable fraction (aPAF). Data analysis was performed from April through September 2023.Main Outcomes and MeasuresWhether or not a diagnostic error took place, the frequency of underlying causes of errors, and harms associated with those errors.ResultsOf 2428 patient records at 29 hospitals that underwent review (mean [SD] patient age, 63.9 [17.0] years; 1107 [45.6%] female and 1321 male individuals [54.4%]), 550 patients (23.0%; 95% CI, 20.9%-25.3%) had experienced a diagnostic error. Errors were judged to have contributed to temporary harm, permanent harm, or death in 436 patients (17.8%; 95% CI, 15.9%-19.8%); among the 1863 patients who died, diagnostic error was judged to have contributed to death in 121 (6.6%; 95% CI, 5.3%-8.2%). In multivariable models examining process faults associated with any diagnostic error, patient assessment problems (aPAF, 21.4%; 95% CI, 16.4%-26.4%) and problems with test ordering and interpretation (aPAF, 19.9%; 95% CI, 14.7%-25.1%) had the highest opportunity to reduce diagnostic errors; similar ranking was seen in multivariable models examining harmful diagnostic errors.Conclusions and RelevanceIn this cohort study, diagnostic errors in hospitalized adults who died or were transferred to the ICU were common and associated with patient harm. Problems with choosing and interpreting tests and the processes involved with clinician assessment are high-priority areas for improvement efforts.
Publisher
American Medical Association (AMA)
Subject
Internal Medicine
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