Diagnostic Errors & Clinical Deterioration

A recent study published in JAMA found that many medical patients who died or were transferred to an ICU experienced a diagnostic error during their care. The retrospective cohort study looked at a random sample of adults with general medical conditions who were transferred to an ICU, died, or both while hospitalized at 29 academic medical centers in the US in 2019. Each record was reviewed to determine if a diagnosis was missed or delayed, identify diagnostic process faults, and classify harms. 

Of the 2,428 patient records reviewed (mean age, 63.9yo), 23% revealed a diagnostic error. Errors were judged to have contributed to temporary or permanent harm or death in 17.8%. A few examples are provided: 

Source: Auerbach et al. JAMA Intern Med. 2024

Researchers used multivariable models to examine process faults and determine an adjusted proportion attributable fraction (aPAF) to the diagnostic errors. They found that patient assessment problems and problems with test ordering and interpretation offered the most opportunity to reduce errors: 

Source: Auerbach et al. JAMA Intern Med. 2024

The authors noted that estimates of diagnostic error vary widely and that these results “fall in the upper end of the range defined in previous studies.” They cautioned that the findings apply only to the select sample of hospital patients who experience clinical deterioration.

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