Diagnostic Error

Improving the quality of diagnostic decision making has been at the heart of Isabel Healthcare’s mission since 1999. Back then there weren’t any resources on diagnostic error but now the issue is a priority there is a large and growing body of evidence. Highlighted below are our top 10 suggested resources on diagnostic error.

Improving Diagnosis in Health Care

First has to be the landmark IOM report. It is quite academic and weak on healthcare IT and measurement but is clear in calling it a ‘moral, professional and public health imperative’ to improve diagnosis.

The frequency of diagnostic errors in outpatient care: estimations from three large observational studies involving US adult populations

This was one of the first studies to look at the quantum of diagnostic error in the outpatient setting.

Types and Origins of Diagnostic Errors in Primary Care Settings

This looks at the type of diagnostic error in primary care and highlights how most of the errors are around common diseases with atypical presentations as opposed to rare diseases and cancers as generally thought.

Physicians' diagnostic accuracy, confidence, and resource requests: a vignette study

The study conclusion; “Our study suggests that physicians’ level of confidence may be relatively insensitive to both diagnostic accuracy and case difficulty” is very revealing.

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MacDonald OW. Physician perspectives on preventing diagnostic errors

Although not a peer reviewed study this white paper is valuable as it captures the views of over 6,000 physicians.

25-Year summary of US malpractice claims for diagnostic errors 1986–2010: an analysis from the National Practitioner Data Bank

This is the definitive study to quantify the proportion of malpractice claims due to diagnostic error as it looks at over 350,000 claims over a 25 year period.

Utility of Clinical Examination in the Diagnosis of Emergency Department Patients Admitted to the Department of Medicine of an Academic Hospital

This study shows the old adage that 80% of the time the patient’s story will tell you the diagnosis is correct. It concluded that a good history and examination were crucial in getting the diagnosis while basic tests alone were not very helpful.

Diagnostic Errors in Primary Care: Lessons Learned

This is one of the main studies to look at the types of diagnostic error in primary care and conclude that one of the main solutions would be broadening the differential diagnosis.

Diagnostic errors in the intensive care unit: a systematic review of autopsy studies

One of the main ways to judge the amount of diagnostic error is through autopsy studies. This study is a systematic review of nearly 6,000 cases.

Diagnostic Error in Internal Medicine

This is the landmark study by Mark Graber which highlighted that ‘premature closure’ was the leading cause of diagnostic error.