Bringing diagnosis into the quality and safety equations

Abstract

Cases of delayed, missed, and incorrect diagnosis are common, with an incidence in the range of 10% to 20%. Some errors in diagnosis stem from mistakes in the interpretation of diagnostic tests. For example, pathology, radiology, and the clinical laboratory each have error rates of 2% to 5%. Superimposed on these testing errors are the ubiquitous system-related errors encountered in every health care organization, as well as cognitive errors caused by faulty clinical reasoning. Diagnostic errors do not occur only in connection with unusual conditions but span the breadth of clinical medicine, from rare disorders to commonplace ones like anemia and asthma.
.Most diagnostic errors are either inconsequential or discovered in time, but others are not. Based on the findings from large autopsy series, Leape et al4 estimated that diagnostic error accounts for 40 000 to 80 000 deaths per year, and the number of patients who are injured must be substantially higher. In a recent survey of more than 6000 physicians, 96% felt that diagnostic errors were preventable.