[EXTERNAL] [IMPROVEDX] quick ?

Leonard Berlin lberlin at LIVE.COM
Thu Apr 24 20:13:21 UTC 2014


The data were published about 8-10 years ago, and at the time was inclusive of all types of radiological exams.  
 
These are, of course, averages, and the great majority of exams were normal.
 
There are other retrospective reports, in which a group of known abnormal CTs, or MRIs, or mammograms, are given blindly to a group of radiologists.  The average "miss" rate is in the 30% range.  
 
Autopsy studies also show a "missed diagnosis" rate of 25%-30%.
 
Lenny Berlin
 
Date: Thu, 24 Apr 2014 11:57:19 -0700
From: rmsbell at ESEDONA.NET
Subject: Re: [IMPROVEDX] [EXTERNAL] [IMPROVEDX] quick ?
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG

Is that for all radiological evaluations, CT, MRI, standard Xray, hard tissue, soft tissue, breasts, etc., etc?
Seems low to me.
Rob Bell




On Apr 23, 2014, at 12:00 PM, Leonard Berlin <lberlin at LIVE.COM> wrote:There are reliable data in the radiologic literature that indicate that the average error rate among radiologists' interpretation of radiographic exams is approximately 3%.  Fortunately, most of these errors are inconsequential clinically.
 
Lenny
 
Leonard Berlin, MD, FACR
Radiology Department, Skokie Hospital
Skokie, IL;
Professor of Radiology
Rush University, and
University of Illinois
Chicago, IL
 

 
> Date: Wed, 23 Apr 2014 13:32:12 -0400
> From: Mark.Graber at VA.GOV
> Subject: Re: [IMPROVEDX] [EXTERNAL] [IMPROVEDX] quick ?
> To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> 
> 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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