Diagnostic errors are a leading cause of liability claims, and a new report examines where the major vulnerabilities lie in the diagnostic process.
Coverys, a Boston-based medical liability insurer, examined (PDF) 10,618 closed medical professional liability claims from 2013-2017 to determine areas for improvement in diagnostic accuracy. The research team was surprised to find that one step that is ripe for error is the initial gathering of a patient's medical and family history, Robert Hanscom, one of the report's co-authors and vice president of business analytics at Coverys, told FierceHealthcare in an interview.
The study found that 3,466 (33%) of the closed claims were related to diagnostic error and could be linked to this step in the process, These claims also account for 26% of the total paid indemnity. Common mistakes include a failure to get a complete history or to conduct a thorough physical exam.
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"If a patient's clinical profile and their family's clinical profiles, to some degree, are not tapped into, it's very possible that things will start getting missed," Hanscom said.
Having a complete patient profile is crucial to guiding the diagnostic process, he said, including determining a patient's need for age-based or genetics-based screening.
More than half of claims included in the study were linked to errors at the diagnostic or lab testing stage. Errors in testing accounted for 52% of errors and 55% of indemnity paid. The real risk, the team found, was in radiology, "in particular missed or delayed cancer diagnoses," Hanscom said.
"That misinterpretation of results was much higher than we were expecting," Hanscom said.
The report offers several ways that providers can avoid diagnostic errors at both of these steps, including:
- Create a checklist for gathering patient histories and conducting initial physicals
- Make updating family histories routine; one strategy is to take advantage of prompts and notifications included in electronic health records
- Invest in clinical decision support tools to ensure physicians are ordering appropriate tests. Use two or more identifiers on patient specimens to ensure accurate test results. Allow patients to access results for outstanding tests and provide contact information for clarification.
Hanscom, who has been studying diagnostic errors for nearly two decades, said that though there has been a greater push to address this problem, it has not "caught fire the way it needs to" and the way other issues, such as hospital-acquired infection rates, have.
He said there needs to be a greater focus on gathering data on diagnostic mistakes to allow physicians to address the problem.
"It's a hard [issue] to keep them focused on because there's not a lot of active data," he said. "This one is really hidden behind the scenes in a great many ways."