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Posted on 01/10/2024 10:54:30 PM PST by SeekAndFind
Diagnostic errors in U.S. hospitals are sending nearly one in four patients to the intensive care unit, according to the results of a new study.
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In the cohort study conducted by a team from UC San Francisco and the University of Colorado School of Medicine, it was found that 23 percent of patients either received incorrect diagnoses or experienced delays in diagnosis. Of these cases, 17 percent resulted in temporary or permanent harm to the patient.
The study’s results are published in the January edition of the Journal of the American Medical Association.
To determine diagnostic errors, the research team looked at 2,428 records of patients who had been admitted to 29 hospitals across the United States in 2019. A little over half of the patient records were male (54 percent), and the average age of the patient was 63.9 years old. Roughly two-thirds of the patients were white.
Patient cases were reviewed by two physicians trained in error adjudications. The physicians evaluated medical records for the presence or absence of diagnostic errors or underlying process issues or faults. Any records marked for fault were then reviewed more closely to determine what, if any, harm was caused as a result of the error.
The physicians had to agree on their assessment of the error and harm caused before finalizing their review; a third physician resolved any disagreements.
In total, 550 patients experienced a diagnostic error. Of these, 436 patients suffered temporary or permanent harm or death as a result of the error. Among the 1,863 patients who died, diagnostic errors were found to contribute to 121 of those deaths, accounting for nearly one in 10.
In 116 cases, diagnostic errors resulted in extended hospital stays. The most significant risks for diagnostic error were identified as issues in patient assessment and problems related to the ordering and interpretation of tests.
“Results from our study provide impetus for rapid exploration and testing of interventions seen to reduce diagnostic errors and harms associated with ICU transfer and deaths by targeting gaps in test selection and interpretation and physicians’ ability to debias and rethink diagnoses as high-priority areas,” the research team concluded.
In a case involving assessment error and patient monitoring, a patient with group B strep infection in their foot was admitted to the hospital. The care team primarily focused on the patient’s meningitis and did not have a plan for treating the foot infection. Consequently, the patient was transferred to the intensive care unit due to poor blood flow and underwent surgical debridement of their foot.
In another case related to testing, a patient on long-term anticoagulation therapy was admitted to the hospital with a hematoma just days following a bone marrow biopsy. The care team resumed anticoagulation therapy on the patient’s fifth day, which exacerbated the patient’s pain and led to tachycardia, a condition characterized by a heart rate exceeding 100 beats per minute. The patient remained in this state for an additional nine hours until CT scans revealed interventional radiology was required.
In a case involving misdiagnosis, a patient who was admitted to the hospital with severe aortic stenosis died after the care team failed to recognize that the patient was in shock. The research team observed that the hospital utilized surgical services to triage the patient, who was experiencing tachycardia, instead of opting for critical care or medical services.
According to the study, “problems related to testing, such as choosing the correct test, ordering the test in a timely fashion, or correctly interpreting the results and problems with assessment, such as recognizing complications or revisiting a different diagnosis, appear to be the most important targets for safety improvement programs.”
The research team noted their study failed to capture the constant pressure on hospital care teams, such as workload and staffing shortages, which likely influence the professional standard of care.
An October 2023 report from Kaufman Hall, a health care consulting firm, confirmed that two-thirds of hospitals across the United States are operating below full capacity due to staffing shortages. Additionally, 70 percent of these hospitals report that patients remain in emergency rooms due to a lack of staffing or bed capacity.
The report includes responses from 106 hospital and health system executives.
The research team noted their study failed to capture the constant pressure on hospital care teams, such as workload and staffing shortages, which likely influence the professional standard of care.....”
I have two comments.
The first is that Artificial Intelligence is being touted as the end all and be all of the future. One of the examples is that AI can more accurately and quickly examine CT & MRI's for underlying medical conditions than most doctors. So AI may help ease some of the testing and diagnosis errors due to under-staffing pressure.
My second comment is that it has long been known in just about every “industry” that a Total Quality Management program reduces errors and improves quality. A very famous TQM example was a dramatic reduction in heart attack deaths after a hospital with a bad track record implemented a TQM program. The doctors and nurses really pushed back, but they didn't want their patients dying on them and once they saw the result they became missionaries.
TQM and the concept of continuous improvement as implemented through objective outcome measurements and Kaizen team process improvement works. It just needs strong leadership to implement. These concepts have been demonstrated to work in the health care field.
I came close to this in 2019. I was admitted to a hospital due to a brain scan. The doctors disagreed on a diagnosis and sent me home after 4 days.
Sending me home was very Providential and saved my life. My wife prayed that they would do this. She was able to take me in to see my primary physician. He recognized my symptoms and called a doctor from Barrows Neurological that he had on speed dial. She gave him some simple tests to perform which validated his assessment. She saw me the next day. I was already going comatose in her office. They took me to St. Joseph’s hospital next to Barrows and operated the next day.
Both the original doctors were wrong. If I had gone comatose in the original hospital, I would have been sent to ICU and would have been dead within the week. My doctor said that these other doctors were just following normal protocols.
My problem was that all of my brain fluid had leaked out of my spine. My brain cavity was filled with blood. Your brain does not float in blood and mine was sitting on bone. Once they located and stopped the leak, the brain fluid replenished and displaced the blood.
It took several months for total rehabilitation. I am an engineer and I currently lead a small team which migrated a mainframe computer system to a Google Cloud instance. So, yes, I am rehabilitated. 😀
Good story; thanks. Bless you.
Most importantly, were the tests and diagnostics billed correctly?
Its called iatrogenic deaths.
They are far more common than anyone is led to believe. They are often hushed up.
This article confirms whats been said for decades.
it just so happens any stay in ICU will be charged to the insurance company at a much higher rate than a normal room.
It should read 23% of ICU patients (or who died or both) had a diagnostic error.
There is a difference. The abstract doesn't say but say 250,000 patients had been in the hospital over the time they randomly selected the 2.4k patients who died or were sent to the ICU or both (estimated from the fact that most hospitals have about 10% ICU beds).
That would be 2.3% of patients will experience an error that will put them in the ICU or kill them or both.
TQM or AI...it still takes smart, committed, kind pros to make those systems work. What can happen is that the folks who work start thinking that TQM or AI is flawless and stop being alert to the imperfections of those initiatives and then mistakes and total BS happens.
Perfect example...we used to have our smart infusion pumps calculate infusion rates of Intravenous solutions...supposed to decrease error rates...right? Soon, the nurses were less proficient at doing the arithmetic...and needed help to calculate a rate when a non standard solution was available. Demanded a new infusion bag with standard concentration.
This is a problem easily solved with more diversity and equity.
EC
I learned a lot about the medical industrial complex in 2020
“It should read 23% of ICU patients (or who died or both) had a diagnostic error.”
Thank you. I had a strong sense that the headline had misstated the statistical situation, and I was looking for the part that would explain basically what you just said.
Errors in Health Care: A Leading Cause of Death and Injury National Academy of Sciences, 2000
Medical error—the third leading cause of death in the US BMJ, 2016
Medical Errors Are No. 3 Cause Of U.S Deaths, Researchers Say NPR, 2016.
And then of course, there is "safe and effective" now joined by "I don't recall."
Last I heard, medical mistakes was one of the leading causes of death in this country.
Best to keep yourself healthy and avoid the current medical establishment as much as possible.
You may be interested in these books, which is on neuroplasticity and includes brain injuries.
The Brain that Changes Itself and The Brain’s Way of Healing, both by Norman Doidge. We initially checked them out of the library and liked them so much that we ordered copies for ourselves.
We’ve learned to check our local library and check books out first. Some recommended books are worth it and others we thought would have been a waste of money.
Big Med kills more people annually than cars and firearms.
When do we ban Big Med.
An October 2023 report from Kaufman Hall, a health care consulting firm, confirmed that two-thirds of hospitals across the United States are operating below full capacity due to staffing shortages.
Hmmm, now, just what could be causing these hospital staffing shortages?? 🤔
“Misdiagnosis” in 23% of patients means that ER doctors were able to correctly improve the pre-visit conditions of 77% of arrivals. It’s probable that some of the resulting ICU cases worsened. However, it’s probable that further diagnosis in the ICU improved patient outcomes from how they would have been without the ER visits. ER’s are the final resort for many admittees. It’s supposed to work that way.
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