[EXTERNAL] [IMPROVEDX] quick ?

Alan Morris Alan.Morris at IMAIL.ORG
Wed Apr 23 19:21:17 UTC 2014


Thank you both.  I will review the Graber and Singh papers in detail soon.
However, I am concerned that this is an underestimate.  While I have not
worked dirtily in diagnostic error domain, my experience in the treatment
realm is quite different.  Error rates as high as 50% are reported.
Strikingly, the remarkable study of Gopher et al., at the Hebrew
University Hospital in an tightly supervised ICU, revealed a 1% error
rate.  This is a remarkable clinician correct performance of 99%.  Even
so, the 1% error was associate with a major threat to life or limb for
every patient every other day, on average!
Have  a nice day.

Alan H. Morris, M.D.
Professor of Medicine
Adjunct Prof. of Medical Informatics
University of Utah

Director of Research
Director Urban Central Region Blood Gas and Pulmonary Laboratories
Pulmonary/Critical Care Division
Sorenson Heart & Lung Center - 6th Floor
Intermountain Medical Center
5121 South Cottonwood Street
Murray, Utah  84157-7000, USA

Office Phone: 801-507-4603
Mobile Phone: 801-718-1283
Fax: 801-507-4699
e-mail: alan.morris at imail.org
e-mail: alanhmorris at gmail.com



On 4/23/14, 12:45 PM, "Pauker, Stephen" <SPauker at TUFTSMEDICALCENTER.ORG>
wrote:

>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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