Prevalence and Causes of Diagnostic Errors in Hospitalized Patients Under Investigation for COVID-19.

Adult Humans COVID-19 / epidemiology Retrospective Studies Pandemics Prevalence Diagnostic Errors COVID-19 Testing

Journal

Journal of general internal medicine
ISSN: 1525-1497
Titre abrégé: J Gen Intern Med
Pays: United States
ID NLM: 8605834

Informations de publication

Date de publication:
Jun 2023
Historique:
received: 04 12 2022
accepted: 13 03 2023
medline: 19 6 2023
pubmed: 24 3 2023
entrez: 23 3 2023
Statut: ppublish

Résumé

The COVID-19 pandemic required clinicians to care for a disease with evolving characteristics while also adhering to care changes (e.g., physical distancing practices) that might lead to diagnostic errors (DEs). To determine the frequency of DEs and their causes among patients hospitalized under investigation (PUI) for COVID-19. Retrospective cohort. Eight medical centers affiliated with the Hospital Medicine ReEngineering Network (HOMERuN). Adults hospitalized under investigation (PUI) for COVID-19 infection between February and July 2020. We randomly selected up to 8 cases per site per month for review, with each case reviewed by two clinicians to determine whether a DE (defined as a missed or delayed diagnosis) occurred, and whether any diagnostic process faults took place. We used bivariable statistics to compare patients with and without DE and multivariable models to determine which process faults or patient factors were associated with DEs. Two hundred and fifty-seven patient charts underwent review, of which 36 (14%) had a diagnostic error. Patients with and without DE were statistically similar in terms of socioeconomic factors, comorbidities, risk factors for COVID-19, and COVID-19 test turnaround time and eventual positivity. Most common diagnostic process faults contributing to DE were problems with clinical assessment, testing choices, history taking, and physical examination (all p < 0.01). Diagnostic process faults associated with policies and procedures related to COVID-19 were not associated with DE risk. Fourteen patients (35.9% of patients with errors and 5.4% overall) suffered harm or death due to diagnostic error. Results are limited by available documentation and do not capture communication between providers and patients. Among PUI patients, DEs were common and not associated with pandemic-related care changes, suggesting the importance of more general diagnostic process gaps in error propagation.

Sections du résumé

BACKGROUND BACKGROUND
The COVID-19 pandemic required clinicians to care for a disease with evolving characteristics while also adhering to care changes (e.g., physical distancing practices) that might lead to diagnostic errors (DEs).
OBJECTIVE OBJECTIVE
To determine the frequency of DEs and their causes among patients hospitalized under investigation (PUI) for COVID-19.
DESIGN METHODS
Retrospective cohort.
SETTING METHODS
Eight medical centers affiliated with the Hospital Medicine ReEngineering Network (HOMERuN).
TARGET POPULATION METHODS
Adults hospitalized under investigation (PUI) for COVID-19 infection between February and July 2020.
MEASUREMENTS METHODS
We randomly selected up to 8 cases per site per month for review, with each case reviewed by two clinicians to determine whether a DE (defined as a missed or delayed diagnosis) occurred, and whether any diagnostic process faults took place. We used bivariable statistics to compare patients with and without DE and multivariable models to determine which process faults or patient factors were associated with DEs.
RESULTS RESULTS
Two hundred and fifty-seven patient charts underwent review, of which 36 (14%) had a diagnostic error. Patients with and without DE were statistically similar in terms of socioeconomic factors, comorbidities, risk factors for COVID-19, and COVID-19 test turnaround time and eventual positivity. Most common diagnostic process faults contributing to DE were problems with clinical assessment, testing choices, history taking, and physical examination (all p < 0.01). Diagnostic process faults associated with policies and procedures related to COVID-19 were not associated with DE risk. Fourteen patients (35.9% of patients with errors and 5.4% overall) suffered harm or death due to diagnostic error.
LIMITATIONS CONCLUSIONS
Results are limited by available documentation and do not capture communication between providers and patients.
CONCLUSION CONCLUSIONS
Among PUI patients, DEs were common and not associated with pandemic-related care changes, suggesting the importance of more general diagnostic process gaps in error propagation.

Identifiants

DOI: 10.1007/s11606-023-08176-6 PMID: 36952085 PMC: PMC10035474
pubmed: 36952085
doi: 10.1007/s11606-023-08176-6
pii: 10.1007/s11606-023-08176-6
pmc: PMC10035474
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

1902-1910

Subventions

Organisme : AHRQ HHS
ID : R01 HS027369
Pays : United States

Commentaires et corrections

Type : CommentIn
Type : CommentIn

Informations de copyright

© 2023. The Author(s).

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Auteurs

Andrew D Auerbach (AD)

Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA. ada@medicine.ucsf.edu.
ORCID: 0000-0001-8440-0527

Gopi J Astik (GJ)

Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.

Kevin J O'Leary (KJ)

Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.

Peter N Barish (PN)

Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.

Molly A Kantor (MA)

Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.

Katie R Raffel (KR)

Division of Hospital Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.

Sumant R Ranji (SR)

Division of Hospital Medicine, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA.

Stephanie K Mueller (SK)

Hospital Medicine Unit, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA.

Sharran N Burney (SN)

Brigham and Women's Faulkner Hospital, Boston, MA, USA.

Janice Galinsky (J)

Brigham and Women's Faulkner Hospital, Boston, MA, USA.

Esteban F Gershanik (EF)

Hospital Medicine Unit, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA.

Abhishek Goyal (A)

Hospital Medicine Unit, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA.

Pooja R Chitneni (PR)

Hospital Medicine Unit, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA.

Sarah Rastegar (S)

Brigham and Women's Faulkner Hospital, Boston, MA, USA.

Armond M Esmaili (AM)

Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.

Cynthia Fenton (C)

Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.

Anunta Virapongse (A)

Division of Hospital Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.

Li-Kheng Ngov (LK)

Division of Hospital Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.

Marisha Burden (M)

Division of Hospital Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.

Angela Keniston (A)

Division of Hospital Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.

Hemali Patel (H)

Division of Hospital Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.

Ashwin B Gupta (AB)

Division of Hospital Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.
Division of Hospital Medicine, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.

Jeff Rohde (J)

Division of Hospital Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.

Ruby Marr (R)

Division of Hospital Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.

S Ryan Greysen (SR)

Section of Hospital Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.

Michele Fang (M)

Section of Hospital Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.

Pranav Shah (P)

Section of Hospital Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.

Frances Mao (F)

Section of Hospital Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.

Farah Kaiksow (F)

Division of Hospital Medicine, University of Wisconsin School of Medicine and Public Health, WI, Madison, USA.

David Sterken (D)

Division of Hospital Medicine, University of Wisconsin School of Medicine and Public Health, WI, Madison, USA.

Justin J Choi (JJ)

Department of Medicine, Weill Cornell Medical College, New York, NY, USA.

Jigar Contractor (J)

Department of Medicine, Weill Cornell Medical College, New York, NY, USA.

Abhishek Karwa (A)

Division of Hospital Medicine, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA.

David Chia (D)

Division of Hospital Medicine, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA.

Tiffany Lee (T)

Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.

Colin C Hubbard (CC)

Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.

Judith Maselli (J)

Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.

Anuj K Dalal (AK)

Hospital Medicine Unit, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA.

Jeffrey L Schnipper (JL)

Hospital Medicine Unit, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA.

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questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Prevalence and Causes of Diagnostic Errors in...
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questionsmedicales.fr › Maladies de l'appareil respiratoire › Infections de l'appareil respiratoire › Pneumopathie infectieuse › Pneumopathie virale › COVID-19 › Prevalence and Causes of Diagnostic Errors in...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › Prevalence and Causes of Diagnostic Errors in...
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