Measuring the Rate of Diagnostic Error in Medicine Could Reduce Injuries, Fatalities

RESEARCH TRIANGLE PARK, N.C.—Diagnostic error in medicine can be prevented and reduced if the rate of error is measured properly, according to a new article by RTI International researcher Mark Graber, M.D.

The commentary, published online in the British Medical Journal of Quality and Safety summarizes existing methods used to estimate the rate of diagnostic error, including autopsies, surveys of patients and providers, voluntary reporting systems, diagnostic testing audits, case reviews, second reviews, and malpractice claims.

According to the commentary, these research approaches all suggest that the incidence of diagnostic error is unacceptably high, in the range of 10 -15 percent of cases.  In aggregate, diagnostic error is estimated to cause 40,000 – 80,000 deaths annually in the United States, making it the 6th leading cause of death.

Unfortunately, none of these research approaches is suitable for measuring the incidence of diagnostic error in daily practice, says Graber.

“Diagnostic error rates are being measured in few, if any, healthcare organizations in the U.S.,” said Graber, a senior fellow in the health care quality and outcomes program at RTI. “Measuring the rate of error, and error-related harm, would provide the necessary motivation to begin addressing this largely unseen issue.”

In the commentary, Graber assess the merits and limitations of current measurements. He then suggests new approaches to improve the measurement of diagnostic errors.  Recommended approaches include encouraging and facilitating voluntary or prompted reports from both patients and physicians, and health care organizations using trigger tools to identify diagnostic error from electronic medical records.

According to Graber, major stakeholders (physicians, patients, healthcare organizations and insurers) can employ these approaches and interventions to reduce the risk of error and harm.  

“Efforts to address diagnostic error must begin with measurement,” Graber said.

medical records on a shelf

Highlights

  • Diagnostic error in medicine can be prevented and reduced if the rate of error is measured properly
  • Commentary assess the merits and limitations of current measurements, and suggests new approaches
  • Recommended approaches include encouraging and facilitating voluntary or prompted reports from both patients and physicians, and health care organizations using trigger tools to identify diagnostic error from electronic medical records