Don't Blame Hospitals for All Diagnostic Errors

The patient safety movement has long focused on errors in acute and long-term care settings. But now investigators are pointing their research tools at the diagnostic skills of primary care physicians because too often, they're getting it wrong, causing avoidable and significant patient harm as a result.

By backtracking patients whose deterioration necessitated that they be admitted to a hospital or another care setting, researchers could see how clinicians in their office practices forgot or missed certain critical steps that could have averted emergencies that ensued days after patients left the doctors' offices.

"Our goal with this paper is to shine a light on the problems we saw in two large healthcare systems, and offer some hope to other healthcare systems that could use this methodology to understand what types of misdiagnoses they are having," says Hardeep Singh, MD, Chief, Health Policy, Quality and Informatics Program at the Houston Veterans Affairs Medical Center and Baylor College of Medicine.

Singh's paper is published in JAMA Internal Medicine.

By using an electronic health record-based "trigger tool," the researchers were able to look through selected medical records of patients whose conditions declined because they didn't get preventable care. Singh and colleagues found 190 significant errors at these two healthcare settings, which included 68 "unique diagnoses" that were missed by the patients' treating physicians.