Diagnostic errors in U.S. hospitals are sending nearly one in four patients to the intensive care unit, according to the results of a new study.
In the cohort study conducted by a team from UC San Francisco and the University of Colorado School of Medicine, it was found that 23 percent of patients either received incorrect diagnoses or experienced delays in diagnosis. Of these cases, 17 percent resulted in temporary or permanent harm to the patient.
The study’s results are published in the January edition of the Journal of the American Medical Association.
To determine diagnostic errors, the research team looked at 2,428 records of patients who had been admitted to 29 hospitals across the United States in 2019. A little over half of the patient records were male (54 percent), and the average age of the patient was 63.9 years old. Roughly two-thirds of the patients were white.
Patient cases were reviewed by two physicians trained in error adjudications. The physicians evaluated medical records for the presence or absence of diagnostic errors or underlying process issues or faults. Any records marked for fault were then reviewed more closely to determine what, if any, harm was caused as a result of the error.
The physicians had to agree on their assessment of the error and harm caused before finalizing their review; a third physician resolved any disagreements.
In total, 550 patients experienced a diagnostic error. Of these, 436 patients suffered temporary or permanent harm or death as a result of the error. Among the 1,863 patients who died, diagnostic errors were found to contribute to 121 of those deaths, accounting for nearly one in 10.
In 116 cases, diagnostic errors resulted in extended hospital stays. The most significant risks for diagnostic error were identified as issues in patient assessment and problems related to the ordering and interpretation of tests.
“Results from our study provide impetus for rapid exploration and testing of interventions seen to reduce diagnostic errors and harms associated with ICU transfer and deaths by targeting gaps in test selection and interpretation and physicians’ ability to debias and rethink diagnoses as high-priority areas,” the research team concluded.
Case Studies Show How Errors Lead to Harm, Longer Hospital Stays
In a case involving assessment error and patient monitoring, a patient with group B strep infection in their foot was admitted to the hospital. The care team primarily focused on the patient’s meningitis and did not have a plan for treating the foot infection. Consequently, the patient was transferred to the intensive care unit due to poor blood flow and underwent surgical debridement of their foot.
In another case related to testing, a patient on long-term anticoagulation therapy was admitted to the hospital with a hematoma just days following a bone marrow biopsy. The care team resumed anticoagulation therapy on the patient’s fifth day, which exacerbated the patient’s pain and led to tachycardia, a condition characterized by a heart rate exceeding 100 beats per minute. The patient remained in this state for an additional nine hours until CT scans revealed interventional radiology was required.
In a case involving misdiagnosis, a patient who was admitted to the hospital with severe aortic stenosis died after the care team failed to recognize that the patient was in shock. The research team observed that the hospital utilized surgical services to triage the patient, who was experiencing tachycardia, instead of opting for critical care or medical services.
According to the study, “problems related to testing, such as choosing the correct test, ordering the test in a timely fashion, or correctly interpreting the results and problems with assessment, such as recognizing complications or revisiting a different diagnosis, appear to be the most important targets for safety improvement programs.”
The research team noted their study failed to capture the constant pressure on hospital care teams, such as workload and staffing shortages, which likely influence the professional standard of care.
An October 2023 report from Kaufman Hall, a health care consulting firm, confirmed that two-thirds of hospitals across the United States are operating below full capacity due to staffing shortages. Additionally, 70 percent of these hospitals report that patients remain in emergency rooms due to a lack of staffing or bed capacity.
The report includes responses from 106 hospital and health system executives.
