How to Prevent Medical Diagnostic Errors

Reviewing past diagnosis is common in some specialties, such as radiology and pathology, Dr. Eibling said. “They’ll reassess a percentage of cases or films,” he said, and determine their own accuracy rate. “The idea of doing this in a clinical practice is kind of new.” Even a single-physician practice could do something like that, Dr. Shah said. “If the physician sat down with their office manager once a quarter and reviewed 10 charts,” he added, “they could do it over lunch.”

Further, Dr. Shah said, such an exercise could help the practice achieve a key component—practice assessment—of the Maintenance of Certification (MOC), as put forth by the American Board of Medical Specialties. The Affordable Care Act specifically recognizes the MOC as a worthy tool for maintaining and reporting high-quality patient care.

Mimi Kokoska, MD, professor and vice-chair at Indiana University School of Medicine’s department of otolaryngology-head and neck surgery, reviewed 50 consecutive head and neck cancer patients over a three-year period (2009-2012) and tracked diagnostic delays and diagnostic errors. She and her colleagues studied electronic medical records (EMRs) and classified delays and errors using criteria similar to those described in the Institute of Medicine’s patient-safety report, “To Err is Human” (National Academies Press; 2000)

The results of the study, presented at this year’s Combined Otolaryngology Spring Meetings, found 57 diagnostic errors and delays in the 50 patients. That might sound like a lot, but Dr. Kokoska said there’s no way of knowing the denominator or the upper bounds. “How many were possible? Theoretically, we could make 100 errors per patient,” she said.

More important than the numbers was the prevalence of different types of errors. Delays were the most frequent problem: Of the 57 cases identified, 31.6% were clinic delays (more than two weeks from referral) and 26.3% were treatment delays (more than two months of inaction after diagnosis, which includes noncancer-related findings on imaging studies). Misdiagnoses made up 15.8% of the problems. Failure to test and use of outmoded tests were also quantified.

Dr. Kokoska said political concerns can make performing this kind of analysis difficult, but if such studies are not undertaken, “how will we know where to focus evidence-based quality improvement efforts?”

“When diagnosed at an early stage, the prognosis for head and neck cancer is so much better,” she said. “So it’s important.”