[EXTERNAL] [IMPROVEDX] quick ?

Pauker, Stephen SPauker at TUFTSMEDICALCENTER.ORG
Wed Apr 23 18:45:21 UTC 2014


Mark

fully concur.
As you have done, step 1 is to define diagnostic error. When I was
tracking your work
Several years ago, I believe you  had a workable draft definition. Is
that finalized?
Steve




-----Original Message-----
From: Graber, Mark [mailto:Mark.Graber at VA.GOV] 
Sent: Wednesday, April 23, 2014 1:32 PM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: Re: [IMPROVEDX] [EXTERNAL] [IMPROVEDX] quick ?

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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