Diagnostic errors affect patient safety in 7% of patients

Diagnostic errors afflict one in 14 hospitalized patients, according to a new study in BMJ Quality & Safety, with researchers pointing to a number of process failures that lead to adverse patient safety events.

Although the study took place at a single hospital, the researchers stressed that insights into process failures can inform a system of safety that can ultimately promote better outcomes.

Healthcare quality and patient safety are key goals in the U.S. According to a 2023 report from researchers at Mass General Brigham, patient safety events occur in around a quarter of inpatient hospitalizations. Of those adverse events, 23% were deemed preventable and 32% were marked with high clinical severity.

Diagnostic errors (DEs) are one category of adverse patient safety events. DEs are defined by the National Academies of Medicine as "the failure to (a) establish an accurate and timely explanation of the patient's health problem(s) or (b) communicate that explanation to the patient," and, per the BMJ study authors, can be difficult to detect and characterize.

This latest study, also published by researchers from Mass General Brigham, starts to quantify the problem of DEs, starting with DE occurrence at Mass General Brigham itself.

The team looked at a sample of 675 patients hospitalized on general medicine. All of these patients ended up being transferred to the ICU, while 38.5% died within 90 days, 7% had complex medical issues and 2.4% of cases had no high-risk factors.

DEs were all too common among this study sample, the researchers said, with 7.2% of cases involving DEs causing some level of patient harm. That shakes out to around one in 14 hospitalized patients experiencing harm due to a diagnostic error.

For 6.1% of cases, patient harm was considered moderate, while 1.1% of cases experienced severe patient harm. Severe harm was most likely among high-risk patients, the researchers said.

Most of the harmful DEs were due to delays in making a correct diagnosis, and the researchers identified numerous process failures also leading to DEs, including the following:

• Patient assessment.
• Diagnostic testing.
• Specialist consultations.
• Patient experience of care.
• Taking medical histories correctly.

The healthcare industry has long prioritized improving patient safety, and this includes eliminating DEs. Many experts have advocated for a culture of patient safety and no-shame transparency about process errors to begin reimagining better processes to support healthcare quality.

The BMJ study authors likewise flagged AI as a key tool in detecting certain process failures.

"For example, once trained on large cohorts and inclusive of data retrieved from various sources (EHR, institutional safety reporting systems, patients), AI-based tools could facilitate detection of diagnostic uncertainty in initial assessments; complex sequences of diagnostic tests; incorrect study interpretations; discrepancies in consultation recommendations; patient-clinician diagnostic discordance; patient-reported diagnostic concerns; or lack of improvement based on expected clinical course," the researchers wrote.

AI also provides the opportunity for early or timely intervention in diagnostic and medical errors, the team explained.

"Novel approaches, including the use of AI and machine learning, have potential for facilitating more granular surveillance in large subpopulations without highest-risk events (such as the complex clinical events subgroup) than can be achieved by human review of the EHR alone; assessing uncertainty or risk in diagnostic processes; and prompting preventative intervention to promote a culture of diagnostic safety," they concluded.

Sara Heath has covered news related to patient engagement and health equity since 2015.