[No SPF Record] Re: [IMPROVEDX] Transfers/referrals

Rory Jaffe rjaffe at CHPSO.ORG
Tue Jan 9 00:03:23 UTC 2018


And even then, methods of getting counts of diagnostic errors are very insensitive, unless your definition is very limited.

You can get pieces of the answer with some reasonable accuracy—e.g., pathology mis-reads, diagnostic errors resulting in malpractice suits. But getting the big picture? No, don’t think we have any idea. For example, see Graber, M. L. (2013). The incidence of diagnostic error in medicine. BMJ Quality & Safety, 22 Suppl 2(Suppl 2), ii21-ii27. http://doi.org/10.1136/bmjqs-2012-001615.

Clinicians in general do a poor job of documenting their cognitive work, so unless we actively solicit this information from physicians and their patients we’re not going to get anywhere close to an answer.

And then there’s the issue of what diagnostic errors do we care about counting? Misdiagnosing a viral URI as a bacterial infection is more a population health issue than an individual patient safety issue, but each time that happens we’re dealing with a diagnostic error. The implications of this type of error and the types of interventions needed are much different from, say, missed diagnoses of dissecting aneurysms in the ED.

With such a heterogeneous problem as diagnostic error, I’m not sure that counting and lumping all errors together to say, for example, “1/3 of all errors are diagnostic” is of any use.

From: Harry Burke [mailto:harry.burke at gmail.com]
Sent: Monday, January 08, 2018 3:02 PM
To: Society to Improve Diagnosis in Medicine <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>; Rory Jaffe <rjaffe at chpso.org>
Subject: Re: [IMPROVEDX] [No SPF Record] Re: [IMPROVEDX] Transfers/referrals

The incidence depends on how you define diagnostic errors and how you detect diagnostic errors.
Sent from my iPhone

On Jan 8, 2018, at 5:43 PM, Rory Jaffe <rjaffe at CHPSO.ORG<mailto:rjaffe at CHPSO.ORG>> wrote:
There are no reliable estimates of the incidence of diagnostic errors.

Rory

From: robert bell [mailto:0000000296e45ec4-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG]
Sent: Sunday, January 07, 2018 10:58 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
Subject: [No SPF Record] Re: [IMPROVEDX] Transfers/referrals

Dear all,

It is said that of the errors in medicine two thirds are standard errors while one third are diagnostic (does anyone know where those figures came from?).

It this is true then the next question would seem to be what is the impact of standard errors (from computers, hand offs, medication, laboratory and radiology errors, etc., etc.) on diagnostic errors. Is it a  small of large figure? Are there  any estimates?

Then the question arises should we as a community/organization be dealing in someway with all errors and not solely diagnostic.

In fact, if the standard errors significantly effect diagnoses, will we be able to easily prove that any diagnostic approach is worthwhile?

Will historical analyses work? How would you compensate for standard error rates being different in different hospitals and HC facilities.

Do we need to know the level of effect of standard errors on diagnostic errors in different facilities?

Robert Bell, M.D.


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