[EXTERNAL] [IMPROVEDX] quick ?

Graber, Mark Mark.Graber at VA.GOV
Wed Apr 23 17:32:12 UTC 2014


Stephen,

We (I) believe the risk of diagnostic error in general medical settings in the US is in the range of 10 - 15%  (Graber.  The Incidence of Diagnostic Error in Medicine;  BMJ Qual Saf 2013;22:ii21-ii27. doi:10.1136/bmjqs-2012-001615).  That's all errors, most of which (thankfully) are inconsequential or caught.  The risk of harm is clearly much less and its hard to put a number on that.

The news stories centered on Hardeep's recent article  ( The frequency of diagnostic errors in outpatient care: estimations from three large observational studies
involving US adult populations.  Singh H, et al. BMJ Qual Saf 2014;0:1-5. doi:10.1136/bmjqs-2013-002627) where they identified a risk of approximately 5% from chart reviews in primary care clinics.  That number is in the 10-15% ballpark, given that the approach would have missed errors that weren't obvious from the medical record, and errors for which the consequences played out elsewhere, and other methodologic issues.

All of these numbers are based on research approaches.  So far, there aren't any healthcare organizations I know of that are measuring error rates in real time, and the challenges of actually doing this are substantial.  We have little data on the error rate for surgical patients, or patients seen in the ER.  There is a great need for research on this question, and for finding reliable and reproducible ways to find and count these errors going forward.  You can't improve what you can't measure.

Mark

Mark L Graber, MD FACP
Senior Fellow, RTI International
Professor Emeritus, SUNY Stony Brook School of Medicine
Founder and President, Society to Improve Diagnosis in Medicine
Phone:   919 990-8497


________________________________
From: "Pauker, Stephen" <SPauker at TUFTSMEDICALCENTER.ORG>
Reply-To: Society to Improve Diagnosis in Medicine <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>, "Pauker, Stephen" <SPauker at TUFTSMEDICALCENTER.ORG>
Date: Wed, 23 Apr 2014 12:01:55 -0400
To: <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
Subject: [EXTERNAL] [IMPROVEDX] quick ?

What # is quoted for freq of diag errors in routine practice
without reference to selection bias??

I think I heard a news story quoting something like 40% of encounters or patients.
Hard to believe that # which seems grossly inflated

Steve
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