[EXTERNAL] [IMPROVEDX] quick ?

robert bell rmsbell at ESEDONA.NET
Thu Apr 24 00:39:48 UTC 2014


Alan et al,

I recall that old post-mortem studies of patients in ICUs had a 20 - 40 percent error rate.

I found this link to one study.

http://www.ncbi.nlm.nih.gov/pubmed/10075053

The undiagnosed infections are interesting.

Rob Bell




On Apr 23, 2014, at 12:21 PM, Alan Morris <Alan.Morris at IMAIL.ORG> wrote:

> 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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> 
> 
> 
> Moderator: Lorri Zipperer Lorri at ZPM1.com, Communication co-chair, Society for Improving Diagnosis in Medicine
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