Burden of Harm from Diagnostic Error Still High
October 1, 2023 4 minutes read
EXECUTIVE SUMMARY
Diagnostic errors kill or permanently disable almost 800,000 Americans per year. Three diseases account for most of the harm.
- Fifteen diseases account for half of the serious harms.
- The data can help direct risk management efforts regarding diagnostic errors.
- The research may be illuminating to physicians.
A new analysis of diagnostic error data revealed an estimated 795,000 Americans die or are permanently disabled by diagnostic error each year. Vascular events, infections, and cancers account for 75% of the serious harms.
Fifteen diseases account for 50.7% of the total serious harms from diagnostic error. The five conditions causing the most frequent serious harms, accounting for 38.7% of the total, were stroke, sepsis, pneumonia, venous thromboembolism, and lung cancer. Stroke was misdiagnosed in 17.5% of cases, and spinal abscess in 62% of cases.1
Top Errors Should be Priority
The diseases accounting for the greatest number of harms from diagnostic error should become top priority for developing solutions, says lead researcher David Newman-Toker, MD, PhD, director of the Johns Hopkins Armstrong Institute Center for Diagnostic Excellence.
The research is the first population health estimate of the number of patients seriously harmed. It also provides more information about the distribution of the diseases that are involved, Newman-Toker says. The 795,000 seriously harmed with either death or permanent disability is a bigger number than people have seen before for diagnostic errors. That number may be less surprising to risk managers who understand more than most that diagnostic errors are the bottom of the iceberg of patient safety.
“You dive below the surface, and you measure the circumference of the iceberg, and they will say, ‘Oh my gosh, it’s really big down here.’ And then you go five more feet, and you measure the circumference, and it keeps getting bigger. By the time you’re 20 feet below the surface, you realize this is huge,” Newman-Toker explains. “I think that’s kind of what we’re seeing when people are measuring different pieces of the puzzle. As we measure more pieces of the puzzle, we’re realizing it’s a bigger and bigger problem.”
Prioritize Time and Resources
The latest research should be useful in helping risk managers prioritize their time and resources.
“Risk managers should redouble their efforts in some of their highest claim areas, beyond cancer, so that they’re having not only an impact on their bottom line, but at the same time, an impact on the greatest public health benefit of the interventions that are promoted by risk management organizations,” Newman-Toker says. “Stroke is the No. 1 cause of serious harms across all conditions, and stroke is also a top claim in malpractice claims. If somebody has to choose doing something with stroke or cancer and risk management, probably more effort needs to be spent on this stroke side because it’s both an important business issue from a risk management standpoint and an important public health problem that exceeds the sum of a lot of the cancer-related misdiagnosis problems.”
The data also may help risk managers educate physicians about diagnostic errors. Physicians readily acknowledge diagnostic errors occur too frequently but will have a hard time recalling the last time they erred with a diagnosis.
“Risk managers are absolutely aware of this problem and have been for the longest period of time because they know that diagnostic error claims make up a huge fraction of their payout. This research offers them some statistics to point to in their discussions with people about how important diagnostic errors are, and that’s good,” Newman-Toker says.
“In terms of how it informs their day-to-day decision-making, it really is rebalancing some of the efforts a little bit in the direction of conditions that are more common and more commonly misdiagnosed than perhaps indicated by simply looking at claims data,” Newman-Toker adds.
The research also suggests heart attacks probably are overrepresented in claims relative to their numbers because heart attack is the one event that the healthcare system handles very well. Any effort to improve diagnosis for stroke could be modeled after what has been done for heart attack.
“With heart attack, we miss only about 1.5% of the time, and patients are harmed less than 1% of the time. So, 99%-plus of the time, if you’ve got a heart attack, you are not going to be harmed by misdiagnosis. For stroke, that number is only 83%,” Newman-Toker says. “There’s a 17.5% chance, over 10 times the chance, that you’re going to be misdiagnosed, and a 10% chance if you have a stroke that you’re going to be seriously harmed. That number is huge, given that stroke and heart attack are roughly the same frequency — about a million a year.”
REFERENCE
- Newman-Toker DE, Nassery N, Schaffer AC, et al. Burden of serious harms from diagnostic error in the USA. BMJ Qual Saf 2023;bmjqs-2021-014130.
SOURCE
- David Newman-Toker, MD, PhD, Director, Johns Hopkins Armstrong Institute Center for Diagnostic Excellence, Baltimore. Phone: (443) 287-9593.
A new analysis of diagnostic error data revealed an estimated 795,000 Americans die or are permanently disabled by diagnostic error each year. Vascular events, infections, and cancers account for 75% of the serious harms.
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