Diagnostic Errors in Hospitalized Adults Who Died or Were Transferred to Intensive Care
Authors: Auerbach Andrew D. , Lee Tiffany M. , Hubbard Colin C. , Ranji Sumant R. , Raffel Katie , Valdes Gilmer , Boscardin John , Dalal Anuj K. , Harris Alyssa , Flynn Ellen , Schnipper Jeffrey L. ,   UPSIDE Research Group, Feinbloom David , Roy Bethany N. , Herzig Shoshana J. , Wazir Mohammed , Gershanik Esteban F. , Goyal Abhishek , Chitneni Pooja R. , Burney Sharran , Galinsky Janice , Rastegar Sarah , Moore Danielle , Berdahl Carl , Seferian Edward G. , Suri Krithika , Ramishvili Tea , Vedamurthy Deepak , Hunt Daniel P. , Mehta Amisha S. , Katakam Haritha , Field Stephanie A. , Karatasakis Barbara , Beeler Katharina , Himmel Allison M. , Eid Shaker , Gandhi Sonal , Pena Ivonne M. , Ranta Zachary S. , Lipten Samuel D. , Lucier David J. , Walker-Corkery Beth , Kleinman Sween Jennifer , Kirchoff Robert W. , Rieck Katie M. , Kolar Gururaj J. , Parikh Riddhi S. , Burton Caroline , Dugani Chandrasagar , Dapaah-Afriyie Kwame , Finn Arkadiy , Raju Sushma B. , Surani Asif , Segon Ankur , Bhandari Sanjay , Astik Gopi J. , O’Leary Kevin J. , Helminski A. Shams , Anstey James , Zhou Mengyu , Alday Angela E. , Halvorson Stephanie A.C. , Esmaili Armond M. , Barish Peter , Fenton Cynthia , Kantor Molly , Choi Kwang Jin , Schram Andrew W. , Ruhnke Gregory , Patel Hemali , Virapongse Anunta , Burden Marisha , Ngov Li-Kheng , Keniston Angela , Talari Preetham , Romond John B. , Vick Sarah E. , Williams Mark V. , Marr Ruby A. , Gupta Ashwin B. , Rohde Jeffrey M. , Mao Frances , Fang Michele M. , Greysen S. Ryan , Shah Pranav , Kim Christopher S. , Narayanan Maya , Wolpaw Benjamin , Ellingson Sonja M. , Kaiksow Farah A. , Kenik Jordan S. , Sterken David , Lewis Michelle E. , Manwani Bhavish R. , Ledford Russell W. , Webber Chase J. , Vasilevskis Eduard E. , Buckley Ryan J. , Kripalani Sunil B. , Sankey Christopher , Ostfeld-Johns Sharon R. , Gielissen Katherine , Wijesekera Thilan , Jordan Eric , Karwa Abhishek , Churnet Bethlehem , Chia David , Brooks Katherine 
Published: January 2024

Importance

Diagnostic errors contribute to patient harm, though few data exist to describe their prevalence or underlying causes among medical inpatients.

Objective

To determine the prevalence, underlying cause, and harms of diagnostic errors among hospitalized adults transferred to an intensive care unit (ICU) or who died.

Design, Setting, and Participants

Retrospective cohort study conducted at 29 academic medical centers in the US in a random sample of adults hospitalized with general medical conditions and who were transferred to an ICU, died, or both from January 1 to December 31, 2019. Each record was reviewed by 2 trained clinicians to determine whether a diagnostic error occurred (ie, missed or delayed diagnosis), identify diagnostic process faults, and classify harms. Multivariable models estimated association between process faults and diagnostic error. Opportunity for diagnostic error reduction associated with each fault was estimated using the adjusted proportion attributable fraction (aPAF). Data analysis was performed from April through September 2023.

Main Outcomes and Measures

Whether or not a diagnostic error took place, the frequency of underlying causes of errors, and harms associated with those errors.

Results

Of 2428 patient records at 29 hospitals that underwent review (mean [SD] patient age, 63.9 [17.0] years; 1107 [45.6%] female and 1321 male individuals [54.4%]), 550 patients (23.0%; 95% CI, 20.9%-25.3%) had experienced a diagnostic error. Errors were judged to have contributed to temporary harm, permanent harm, or death in 436 patients (17.8%; 95% CI, 15.9%-19.8%); among the 1863 patients who died, diagnostic error was judged to have contributed to death in 121 (6.6%; 95% CI, 5.3%-8.2%). In multivariable models examining process faults associated with any diagnostic error, patient assessment problems (aPAF, 21.4%; 95% CI, 16.4%-26.4%) and problems with test ordering and interpretation (aPAF, 19.9%; 95% CI, 14.7%-25.1%) had the highest opportunity to reduce diagnostic errors; similar ranking was seen in multivariable models examining harmful diagnostic errors.

Conclusions and Relevance

In this cohort study, diagnostic errors in hospitalized adults who died or were transferred to the ICU were common and associated with patient harm. Problems with choosing and interpreting tests and the processes involved with clinician assessment are high-priority areas for improvement efforts.