The incidence of diagnostic errors in UK primary care and implications for health care, research, and medical education: a retrospective record analysis of missed diagnostic opportunities

Abstract

BackgroundDiagnostic errors have recently been identified as a high-priority patient safety problem in primary care by the World Health Organization (WHO). However, no studies exist in UK to quantify the extent of such errors and associated harm in primary care.AimThis study aimed to determine the incidence of ‘missed diagnostic opportunities’ (MDOs) in UK primary care.MethodRetrospective reviews of electronic health records (EHRs). Twenty-one general practices were recruited, sampled by size and deprivation. Pairs of GP-reviewers independently reviewed 100 randomly selected face-to-face consultations with adults in each practice (n = 21), reviewing a 12-month period for consultations containing new diagnostic activity. Records were jointly reviewed where at least one reviewer identified an MDO to gain consensus.ResultsWe reviewed 2070 EHRs; and, 1530 contained some new diagnostic activity. After joint review, at least one clinician thought an MDO was likely/certain in 4.4% (95% CI = 3.2 to 5.8) of these consultations, and both rated an MDO likely/certain in 2.5% (95% CI = 1.6 to 3.9). Final consensus, identified MDO occurrences for 61.4% of the consultations. The overall agreement was higher than other comparable studies (κ statistic 0.68), and 54% (n = 20) of the mutually agreed MDOs (n = 56), were rated as likely to cause moderate or severe patient harm.ConclusionIn this first assessment of MDOs in UK primary care, we found their frequency to be relatively low but human cost relatively high for over half of those experiencing an error. Identifying workable strategies to prevent errors occurring from the identified contributing factors, and prioritising diagnostic errors is the next critical action.