In Search of a Common Definition of Dx Error

Ted.E.Palen at KP.ORG Ted.E.Palen at KP.ORG
Fri May 6 21:52:04 UTC 2016


Hello
I have worked with health data for over 20 years. One thing that we know 
for sure codes do not tell the whole story and in fact may be totally 
misleading.

If something is not coded and you are using administrative data for the 
analysis there is no way to get the information.
Since errors are not coded in the chart, and are definitely not part of a 
death certificate then the estimates from deaths or harms form medical 
errors are just that estimates.
I would hate to see the error bars or confidence intervals on this data.
If it was for determining a treatment effect for a new drug it would never 
see the light of day.



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From:   Leonard Berlin <lberlin at LIVE.COM>
To:     IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Date:   05/06/2016 09:15 AM
Subject:        Re: [IMPROVEDX] In Search of a Common Definition of Dx 
Error



Over the past several days I have enjoyed reading the long list of 
commentaries submitted by very bright and caring physicians. 
medical-associated people,  and researchers,  on the subject of the 
frequency of medical errors and their  role in causing death of patients. 
This has led me to conclude the following undeniable fact: 
 
 NOBODY KNOWS HOW MANY MEDICAL ERRORS ARE COMMITTED, AND NOBODY KNOWS HOW 
MANY PEOPLE ARE KILLED BY MEDICAL ERRORS!
 
The articles by Makary and others that calculate numbers related to 
medical errors and patient injury are nothing more than statistical 
projections,  extrapolations, estimates, and conjectures.  
 
Makary, Johns Hopkins, and the BMJ got great international headlines by 
"estimating" that 251,454 patients die of medical mistakes annually. 
Needless to say, the word "estimating" doesn't appear very much,  if at 
all, in the headlines and limited text proclaimed  in newspaper and TV 
news reports. 
 
Today, physicians  in all specialties are presumably  practicing 
"evidence-based-medicine." 
 
When it comes to medical errors, there is no "evidence!"
 
Yes, focusing attention on medical errors is certainly productive, and 
indeed encourages all of us to improve medical care safety and reduce 
errors.  And clearly, supporting organizations such as  SIDM is a step in 
the right direction.
 
We should be transparent to the public, but frightening everyone and 
causing them to lose confidence in their physicians is counterproductive. 
Our message to the public should be an honest one:  MEDICAL ERRORS DO 
OCCUR, BUT WE DO NOT KNOW, AND WILL NEVER KNOW, HOW MANY PATIENTS DIE DUE 
TO A MEDICAL ERROR; HOWEVER, WE ARE WORKING ON WAYS TO REDUCE THEM.
 
Lenny
Date: Thu, 5 May 2016 14:23:22 -0500
From: ruthryan at COX.NET
Subject: [IMPROVEDX] In Search of a Common Definition of Dx Error
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG

To all, 
 
Allow me to pick the finest brains on this topic.  Should SIDM adopt one 
of these definitions below, or craft a combination of these elements?  How 
would you define it?
 

DEFINITIONS OF DIAGNOSTIC ERROR
 
Author
Source or Citation
Definition
Mark Graber
Diagnostic errors in medicine: a case of neglect. Jt Comm J Qual Patient 
Saf. 2005.
 
Graber ML, Franklin N, Gordon R. Diagnostic error in internal medicine. 
Arch Intern Med. 2005
Medical diagnoses that are wrong, missed, or delayed. 
 
A diagnosis that was unintentionally delayed (sufficient information was 
available earlier), wrong (another diagnosis was made before the correct 
one), or missed (no diagnosis was ever made), as judged from the eventual 
appreciation of more definitive information.
 
Hardeep Singh
 
Helping healthcare organizations to define diagnostic errors as 
opportunities in diagnosis. Jt Comm J Patient Safety, 2014.
 
A breakdown in the diagnostic process and a missed opportunity to have 
made the diagnosis more accurately or more efficiently…regardless of 
whether there was patient harm.
Gordon Schiff et al
Schiff GD, Hasan O, Kim S, Abrams R, Cosby K, Lambert BL, et al. 
Diagnostic Error in Medicine: Analysis of 583 Physician-Reported Errors. 
Arch Intern Med. 2009
Any mistake or failure in the diagnostic process leading to a 
misdiagnosis, a missed diagnosis, or a delayed diagnosis. This could 
include any failure in timely access to care; elicitation or 
interpretation of symptoms, signs, or laboratory results; formulation and 
weighing of differential diagnosis; and timely follow-up and specialty 
referral or evaluation.
 
Institute of Medicine
Improving Diagnosis in Health Care, 2015 report Institute of Medicine 
(IOM)
The failure to establish an accurate and timely explanation of the 
patient's health problem(s) or to communicate that explanation to the 
patient.
 
 
BEST DEFINITION OR COMBINED DEFINITION:
 
Fill in the blank
 

 
 
Ruth
 
Ruth Ryan RN, BSN, MSW, CPHRM
Medical writer
Risk management/patient safety
Continuing medical education
Telephone (504) 256-8797
Email ruthryan at cox.net

 
 


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