Researchers examined diagnostic errors at a large, urban Veterans Affairs facility and a large integrated private health care system. The researchers identified diagnostic errors through electronic health record–based triggers, including patients’ unexpected return visits after an initial primary care visit.
Of 190 instances of diagnostic errors in primary care visits from Oct. 1, 2006 to Sept. 30, 2007, there were a total of 68 unique diagnoses missed. Researchers identified process breakdowns in several areas that were associated with diagnostic errors. Of all cases, 43.7 percent involved more than one of these process breakdowns:
• Patient-practitioner clinical encounter — 78.9 percent
• Referrals — 19.5 percent
• Patient-related factors — 16.3 percent
• Follow-up and tracking of diagnostic information — 14.7 percent
• Performance and interpretation of diagnostic tests — 13.7 percent
Problems in the following areas contributed to breakdowns during the patient-practitioner encounter:
• History-taking — 56.3 percent
• Examination — 47.4 percent
• Ordering diagnostic tests for further workup — 57.4 percent
Furthermore, most errors were associated with the potential for moderate to severe harm, according to the study.
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