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Abdominal pain in the emergency department: missed diagnoses.

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Halsey-Nichols M, McCoin N. Emerg Med Clin North Am. 2021;39:703-717.

Diagnostic errors among patients presenting to the emergency department (ED) with abdominal pain are common. This article summarizes the factors associated with missed diagnoses of abdominal pain in the ED, the types of abdominal pain that are commonly misdiagnosed, and recommended steps for discharging a patient with abdominal pain without a final diagnosis.

Use of artificial intelligence for image analysis in breast cancer screening programmes: systematic review of test accuracy.

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Freeman K, Geppert J, Stinton C, et al. BMJ. 2021;374:n1872.

Artificial intelligence (AI) has been used and studied in multiple healthcare processes, including detecting patient deterioration and surgical decision making. This literature review focuses on studies using AI to detect breast cancer in mammography screening practice. The authors recommend additional prospective studies before using artificial intelligence in clinical practice.

The influence of the availability heuristic on physicians in the emergency department.

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Ly DP. Ann Emerg Med. 2021;78:650-657.

A common type of diagnostic error is availability bias, or diagnosing a patient based on experiences with past similar cases. This study examined whether an emergency physician’s recent experience of a patient presenting with shortness of breath and diagnosed with pulmonary embolism increased subsequent pulmonary embolism diagnoses. While pulmonary embolism diagnosis did increase over the following ten days, that effect did not persist over the 50 days following the first 10 days.

Patient and clinician experiences of uncertainty in the diagnostic process: current understanding and future directions.

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Meyer AND, Giardina TD, Khawaja L, et al. Patient Educ Couns. 2021;104:2606-2615.

Diagnostic uncertainty can lead to misdiagnosis and delayed treatment. This article provides an overview of the literature on diagnosis-related uncertainty, where uncertainty occurs in the diagnostic process and outlines recommendations for managing diagnostic uncertainty.

Oncologic errors in diagnostic radiology: a 10-year analysis based on medical malpractice claims.

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Rosenkrantz AB, Siegal D, Skillings JA, et al. J Am Coll Radiol. 2021;18:1310-1316.

Prior research found that cancer, infections, and vascular events (the “big three”) account for nearly half of all serious misdiagnosis-related harm identified in malpractice claims. This retrospective analysis of malpractice claims data from 2008 to 2017 found that oncology-related errors represented the largest source of radiology malpractice cases with diagnostic allegations. Imaging misinterpretation was the primary contributing factor.

Do my feelings fit the diagnosis? Avoiding misdiagnoses in psychosomatic consultation services.

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Seidl E, Seidl O. J Healthc Risk Manag. 2021;41:9-17.

Diagnostic safety is a patient safety priority across all medical specialties. Over a five-year period, researchers found that 15% of patients referred for psychosomatic consultations at one university hospital were misdiagnosed. Misdiagnosis was primarily attributed to availability bias or other biases. Semi-structured interviews with referring physicians highlight the contributing role of physician attitudes and unusual clinical features.

Filling a gap in safety metrics: development of a patient-centred framework to identify and categorise patient-reported breakdowns related to the diagnostic process in ambulatory care.

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Bell SK, Bourgeois FC, DesRoches CM, et al. BMJ Qual Saf. 2022;31:526-540.

Engaging patients and families in their own care can improve outcomes, safety, and satisfaction. This study brought patients, families, clinicians and experts together to identify patient-reported diagnostic process-related breakdowns. The group identified 7 categories, 40 subcategories, 19 contributing factors and 11 patient-reported impacts. Breakdowns were identified in each step of the diagnostic process.

Should electronic differential diagnosis support be used early or late in the diagnostic process? A multicentre experimental study of Isabel.

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Sibbald M, Monteiro SD, Sherbino J, et al. BMJ Qual Saf. 2022;31:426-433.

Diagnostic safety remains a patient safety priority. This randomized study including emergency medicine and internal medicine physicians as well as medical students found that electronic differential diagnostic support increased the likelihood that the correct diagnosis appeared in the differential, regardless of whether the tool was used early or late in the diagnostic process.

Factors associated with potentially missed acute deterioration in primary care: cohort study of UK general practices.

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Cecil E, Bottle A, Majeed A, et al. Br J Gen Pract. 2021;71:e547-e554.

There has been an increased focus on patient safety, including missed diagnosis, in primary care in recent years. This cohort study evaluated the incidence of emergency hospital admission within 3 days of a visit with a GP with missed sepsis, ectopic pregnancy, urinary tract infection or pulmonary embolism. Shorter duration of appointment and telephone appointment (compared with in person) were associated with increased incidence of self-referred emergency hospital admission.

Analyzing diagnostic errors in the acute setting: a process-driven approach.

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Griffin JA, Carr K, Bersani K, et al. Diagnosis (Berl). 2022;9:77-88.

Diagnostic errors in the acute care setting can result in increased morbidity and mortality. Using the Diagnostic Error Evaluation and Research (DEER) taxonomy, researchers reviewed 16 records of patients whose deaths were associated with at least one medical error. Most (81.3%) patients had at least one diagnostic error and a total of 113 failure points and 30 significant failure points.

The efficacy of mindful practice in improving diagnosis in healthcare: a systematic review and evidence synthesis.

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Pinnock R, Ritchie D, Gallagher S, et al. Adv Health Sci Educ Theory Pract. 2021;26:785-809.

Cognition is a recognized human factor that can contribute to medical error. This systematic review explored whether mindful practice can improve diagnosis in healthcare. Of the 33 included studies, the majority were non-empirical; however, the authors tentatively conclude that mindful practice may be a promising method to improve diagnostic accuracy and reduce error.

Improving Telediagnosis--a Call to Action: Final Project Findings.

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Graber ML, Schrandt S. Evanston, IL: Society to Improve Diagnosis in Medicine; September 8, 2021.

This report summarizes the results of a project that examined how the literature and various stakeholders consider challenges and opportunities for improving diagnosis during telemedicine interactions. Both areas of concern and potential were highlighted to engage researchers, educators, and clinicians in the implementation and use of telediagnosis that is safe and of high-value for patients and families.

Misdiagnosis of acute myocardial infarction: a systematic review of the literature.

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Kwok CS, Bennett S, Azam Z, et al. Crit Pathw Cardiol. 2021;20:155-162.

Misdiagnosis of cardiovascular conditions can lead to serious patient harm. This systematic review found that misdiagnosis of acute myocardial infarction (AMI) occurs in approximately 1-2% of cases, and AMI is commonly diagnosed as other heart conditions, musculoskeletal pain, or gastrointestinal disease. The authors suggest that there are opportunities to reduce cases of missed AMI with better education about atypical symptoms and improved training of electrocardiogram interpretation.

The Contribution of Diagnostic Errors to Maternal Morbidity and Mortality During and Immediately After Childbirth: State of the Science.

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Bajaj K, de Roche A, Goffman D. Rockville, MD: Agency for Healthcare Research and Quality; September 2021. AHRQ Publication No. 20(21)-0040-6-EF.

Maternal safety is threatened by systemic biases, care complexities, and diagnostic issues. This issue brief explores the role of diagnostic error in maternal morbidity and mortality, the preventability of common problems such as maternal hemorrhage, and the importance of multidisciplinary efforts to realize improvement. The brief focuses on events occurring during childbirth and up to a week postpartum.

Use of heuristics during the clinical decision process from family care physicians in real conditions.

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Fernández‐Aguilar C, Martín‐Martín JJ, Minué Lorenzo S, et al. J Eval Clin Pract. 2022;28:135-141.

Heuristics, or the use of mental shortcuts based on experience or trial and error that allow clinicians to quickly assess or diagnose a problem, can sometimes result in misdiagnosis. Three types of heuristics are explored in this study of primary care diagnostic error: representativeness, availability, and overconfidence. While a diagnostic error was identified in nearly 10% of cases, there was no significant correlation between the use of heuristics and diagnostic error.

Safety events impacting hospitalized patients following motor vehicle crashes: a qualitative study of reports from Pennsylvania hospitals.

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Kukielka E. Patient Saf. 2021;3:18-27.

Trauma patients, who often suffer multiple, severe injuries and who may arrive to the Emergency Department (ED) unconscious, are vulnerable to adverse events. Using data reported to the Pennsylvania Patient Safety Reporting System (PA-PSRS), researchers in this study evaluated the safety challenges of caring for patients presenting to the ED after a motor vehicle collision. Common challenges included issues with monitoring, treatment, evaluation, and/or documentation, patient falls, medication errors, and problems with transfers.

Dangers of Missing an Epidural Abscess: Multiple Visits and Delayed Diagnosis with a Severely Negative Outcome

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September 29, 2021

A 44-year-old man presented to his primary care physician (PCP) with complaints of new onset headache, photophobia, and upper respiratory tract infections. He had a recent history of interferon treatment for Hepatitis C infection and a remote history of cervical spine surgery requiring permanent spinal hardware. On physical examination, his neck was tender, but he had no neurologic abnormalities. He was sent home from the clinic with advice to take over-the-counter analgesics.

Detection of missed fractures of hand and forearm in whole-body CT in a blinded reassessment.

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Kim S, Goelz L, Münn F, et al. BMC Musculoskelet Disord. 2021;22:589.

Late diagnosis of upper extremity fractures can lead to delays in treatment. When two radiologists reviewed whole-body CT scans, each missed known fractures and identified previously unknown fractures. Slice thickness was not significantly associated with missed fractures; however, missed and late diagnosis occurred more often between the hours of 5pm and 1am.

Clinical features and preventability of delayed diagnosis of pediatric appendicitis.

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Michelson KA, Reeves SD, Grubenhoff JA, et al. JAMA Netw Open. 2021;4:e2122248.

Diagnostic errors, including delayed diagnoses, continue to be a patient safety concern. This case-control study of children treated at five pediatric emergency departments explored the preventability of delayed diagnosis of pediatric appendicitis and associated outcomes. Researchers estimated that 23% of delayed diagnosis cases were likely to be preventable and that delayed diagnosis led to longer hospital length of stay, higher perforation rates, and additional surgical procedures.

Handshake antimicrobial stewardship as a model to recognize and prevent diagnostic errors

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September 29, 2021

The handshake antimicrobial stewardship program (HS-ASP) was developed and implemented at Children’s Hospital Colorado (CHCO). In 2014, the CHOC HS-ASP team began labeling specific interventions as “Great Catches” which were considered to have altered, or had the potential to alter, the patient’s trajectory of care. CHOC researchers used these "Great Catches" to identify potential diagnostic errors.

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