Missed, wrong diagnoses most dangerous errors, study says

They rarely get the attention paid to never events, such as wrong-site surgery or death from a medication error, but errors involving missed, delayed or incorrect diagnoses are the most common, costly and dangerous mistakes made in the U.S. healthcare system, argue the authors of a study in the journal BMJ Quality & Safety.

Researchers analyzed 25 years of malpractice data from the National Practitioner Data Bank, looking specifically at more than 350,000 claims that led to payouts. Such errors lead to an estimated 40,000 to 80,000 hospital deaths a year in the U.S., according to research cited in the study. More than 25% of the analyzed allegations, or 100,249 claims, were diagnosis-related, with outcomes ranging from death to minor permanent injury, the authors found.

The inflation-adjusted total of all of the diagnosis-related payments was $38.8 billion, according to the study.

Diagnosis-related allegations accounted for considerably more than other malpractice categories, including allegations related to obstetrics and surgery. Also, diagnostic errors “resulted in death or disability almost twice as often as other error categories and accounted for the plurality of these outcomes,” the study authors wrote.

“Overall, diagnostic errors have been underappreciated and under-recognized because they're difficult to measure and keep track of owing to the frequent gap between the time the error occurs and when it's detected,” Dr. David Newman-Toker, an associate professor of neurology at Johns Hopkins University School of Medicine, Baltimore, and the study's lead author, said in a news release. “These are frequent problems that have played second fiddle to medical and surgical errors, which are evident more immediately.”

The researchers also acknowledged that physicians' fear of missing diagnoses can fuel costly overuse of diagnostic testing services. They argued that efforts to curb defensive medicine and reform the tort liability system should consider “specific policies related to diagnostic error.”

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