Diagnostic errors are common in primary care and involve a wide range of diseases, according to newly published research.
Missed, incorrect or delayed diagnoses were most frequent in conditions common in primary-care settings, including pneumonia, congestive heart failure, acute renal failure, cancer and urinary tract infections, according to the study, which appeared in JAMA Internal Medicine
. Researchers analyzed 190 instances of diagnostic errors that occurred over a 12-month period, from October 2006 to September 2007, at the ambulatory-care sites of two large hospitals.
Such errors are likely to remain a nettlesome problem, the authors argued, as long as providers are pressured to keep visits short and make decisions quickly. Still, the authors expressed hope that new models of healthcare delivery and the growing focus on patient engagement and shared decision-making could provide safeguards.
“Most process breakdowns were related to the clinical encounter, wherein practitioners are almost always pressed for time to make decisions,” the authors wrote in the study. “With the current emphasis on patient-centered medical homes that facilitate team-based care, patients might be able to access or interact with their practitioners more effectively.”
Breakdowns in the diagnostic process were at the root of many of the errors, according to the study. For instance, breakdowns during the clinician-patient encounter—including inadequate capture of a patient's medical history and failure to review previous documentation—were to blame for more than 78% of the errors.
Referrals and diagnostic test ordering and interpretation were also areas where breakdowns were common and errors often occurred, they added.
The risk of harm to patients was substantial, with the potential severity of injury associated with the errors reaching “moderate” to “severe” in 86.8% of cases, according to the study.
Researchers also found significant differences in the types of conditions affected by diagnostic errors across the two facilities, suggesting important differences related to patient populations and practitioners, they said.