TY - JOUR
T1 - Prevalence and Causes of Diagnostic Errors in Hospitalized Patients Under Investigation for COVID-19
AU - Auerbach, Andrew D.
AU - Astik, Gopi J.
AU - O’Leary, Kevin J.
AU - Barish, Peter N.
AU - Kantor, Molly A.
AU - Raffel, Katie R.
AU - Ranji, Sumant R.
AU - Mueller, Stephanie K.
AU - Burney, Sharran N.
AU - Galinsky, Janice
AU - Gershanik, Esteban F.
AU - Goyal, Abhishek
AU - Chitneni, Pooja R.
AU - Rastegar, Sarah
AU - Esmaili, Armond M.
AU - Fenton, Cynthia
AU - Virapongse, Anunta
AU - Ngov, Li Kheng
AU - Burden, Marisha
AU - Keniston, Angela
AU - Patel, Hemali
AU - Gupta, Ashwin B.
AU - Rohde, Jeff
AU - Marr, Ruby
AU - Greysen, S. Ryan
AU - Fang, Michele
AU - Shah, Pranav
AU - Mao, Frances
AU - Kaiksow, Farah
AU - Sterken, David
AU - Choi, Justin J.
AU - Contractor, Jigar
AU - Karwa, Abhishek
AU - Chia, David
AU - Lee, Tiffany
AU - Hubbard, Colin C.
AU - Maselli, Judith
AU - Dalal, Anuj K.
AU - Schnipper, Jeffrey L.
N1 - Publisher Copyright:
© 2023, The Author(s).
PY - 2023/6
Y1 - 2023/6
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85150663337&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85150663337&partnerID=8YFLogxK
U2 - 10.1007/s11606-023-08176-6
DO - 10.1007/s11606-023-08176-6
M3 - Article
C2 - 36952085
AN - SCOPUS:85150663337
SN - 0884-8734
VL - 38
SP - 1902
EP - 1910
JO - Journal of general internal medicine
JF - Journal of general internal medicine
IS - 8
ER -