Prevalence and Causes of Diagnostic Errors in Hospitalized Patients Under Investigation for COVID-19

Andrew D. Auerbach*, Gopi J. Astik, Kevin J. O’Leary, Peter N. Barish, Molly A. Kantor, Katie R. Raffel, Sumant R. Ranji, Stephanie K. Mueller, Sharran N. Burney, Janice Galinsky, Esteban F. Gershanik, Abhishek Goyal, Pooja R. Chitneni, Sarah Rastegar, Armond M. Esmaili, Cynthia Fenton, Anunta Virapongse, Li Kheng Ngov, Marisha Burden, Angela KenistonHemali Patel, Ashwin B. Gupta, Jeff Rohde, Ruby Marr, S. Ryan Greysen, Michele Fang, Pranav Shah, Frances Mao, Farah Kaiksow, David Sterken, Justin J. Choi, Jigar Contractor, Abhishek Karwa, David Chia, Tiffany Lee, Colin C. Hubbard, Judith Maselli, Anuj K. Dalal, Jeffrey L. Schnipper

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


Background: The COVID-19 pandemic required clinicians to care for a disease with evolving characteristics while also adhering to care changes (e.g., physical distancing practices) that might lead to diagnostic errors (DEs). Objective: To determine the frequency of DEs and their causes among patients hospitalized under investigation (PUI) for COVID-19. Design: Retrospective cohort. Setting: Eight medical centers affiliated with the Hospital Medicine ReEngineering Network (HOMERuN). Target population: Adults hospitalized under investigation (PUI) for COVID-19 infection between February and July 2020. Measurements: We randomly selected up to 8 cases per site per month for review, with each case reviewed by two clinicians to determine whether a DE (defined as a missed or delayed diagnosis) occurred, and whether any diagnostic process faults took place. We used bivariable statistics to compare patients with and without DE and multivariable models to determine which process faults or patient factors were associated with DEs. Results: Two hundred and fifty-seven patient charts underwent review, of which 36 (14%) had a diagnostic error. Patients with and without DE were statistically similar in terms of socioeconomic factors, comorbidities, risk factors for COVID-19, and COVID-19 test turnaround time and eventual positivity. Most common diagnostic process faults contributing to DE were problems with clinical assessment, testing choices, history taking, and physical examination (all p < 0.01). Diagnostic process faults associated with policies and procedures related to COVID-19 were not associated with DE risk. Fourteen patients (35.9% of patients with errors and 5.4% overall) suffered harm or death due to diagnostic error. Limitations: Results are limited by available documentation and do not capture communication between providers and patients. Conclusion: Among PUI patients, DEs were common and not associated with pandemic-related care changes, suggesting the importance of more general diagnostic process gaps in error propagation.

Original languageEnglish (US)
Pages (from-to)1902-1910
Number of pages9
JournalJournal of general internal medicine
Issue number8
StatePublished - Jun 2023

ASJC Scopus subject areas

  • Internal Medicine


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