Diagnostic Errors: Monumental Problem or Enormous Opportunity?

October 3, 2016 | Healthcare Risk, Quality, & Safety Guidance

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​When Thomas Eric Duncan presented to an emergency department (ED) with fever, a severe headache, nausea, and abdominal pain on September 25, 2014, he told the triage nurse that he had recently traveled from Liberia, where an outbreak of Ebola virus infection was already under way. The physician who evaluated him, however, was unaware of his travel history. After undergoing tests, Duncan was discharged with a diagnosis of sinusitis. He returned to the hospital on September 28, the Ebola diagnosis was confirmed on September 30, and he died on October 8. (NAS)

While Duncan's case was unique in several ways—he was the first person to be diagnosed with Ebola in the United States and the only one of four people diagnosed and treated in this country who did not survive (CDC)—in another way his case is alarmingly not atypical: Based on extrapolations from autopsy studies, an estimated 40,000 to 80,000 deaths due to diagnostic errors occur every year (Leape et al. "Counting Deaths").

Diagnostic error is difficult to measure. But what is known about diagnostic error points to a significant problem in healthcare. Using varied methodologies, studies have found the following:

Not all diagnostic errors harm patients, but when harm does result, it can range from minor to catastrophic. Patients may die or face adverse health, psychological, and financial consequences. Diagnostic errors can also have repercussions beyond a single episode of care. "If you get the diagnosis wrong, everything else that happens downstream is potentially wrong," says Paul Epner, MBA, executive vice president of SIDM.

Diagnostic error is a prime liability concern. "Diagnostic errors are a leading cause of malpractice claims, and these claims are more likely to be associated with patient deaths than other types of medical errors," according to Elisabeth Belmont, Esq., corporate counsel, MaineHealth.

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