Andrew D. Auerbach, Tiffany M. Lee, Colin C. Hubbard, Sumant R. Ranji, Katie Raffel, Gilmer Valdes, John Boscardin, Anuj K. Dalal, Alyssa Harris, Ellen Flynn, Jeffrey L. Schnipper, David Feinbloom, Bethany N. Roy, Shoshana J. Herzig, Mohammed Wazir, Esteban F. Gershanik, Abhishek Goyal, Pooja R. Chitneni, Sharran Burney, Janice Galinsky, Sarah Rastegar, Danielle Moore, Carl Berdahl, Edward G. Seferian, Krithika Suri, Tea Ramishvili, Deepak Vedamurthy, Daniel P. Hunt, Amisha S. Mehta, Haritha Katakam, Stephanie A. Field, Barbara Karatasakis, Katharina Beeler, Allison M. Himmel, Shaker Eid, Sonal Gandhi, Ivonne M. Pena, Zachary S. Ranta, Samuel D. Lipten, David J. Lucier, Beth Walker-Corkery, Jennifer Kleinman Sween, Robert W. Kirchoff, Katie M. Rieck, Gururaj J. Kolar, Riddhi S. Parikh, Caroline Burton, Chandrasagar Dugani, Kwame Dapaah-Afriyie, Arkadiy Finn, Sushma B. Raju, Asif Surani, Ankur Segon, Sanjay Bhandari, Gopi J. Astik, Kevin J. O’Leary, A. Shams Helminski, James Anstey, Mengyu Zhou, Angela E. Alday, Stephanie A.C. Halvorson, Armond M. Esmaili, Peter Barish, Cynthia Fenton, Molly Kantor, Kwang Jin Choi, Andrew W. Schram, Gregory Ruhnke, Hemali Patel, Anunta Virapongse, Marisha Burden, Li-Kheng Ngov, Angela Keniston, Preetham Talari, John B. Romond, Sarah E. Vick, Mark V. Williams, Ruby A. Marr, Ashwin B. Gupta, Jeffrey M. Rohde, Frances Mao, Michele M. Fang, S. Ryan Greysen, Pranav Shah, Christopher S. Kim, Maya Narayanan, Benjamin Wolpaw, Sonja M. Ellingson, Farah A. Kaiksow, Jordan S. Kenik, David Sterken, Michelle E. Lewis, Bhavish R. Manwani, Russell W. Ledford, Chase J. Webber, Eduard E. Vasilevskis, Ryan J. Buckley, Sunil B. Kripalani, Christopher Sankey, Sharon R. Ostfeld-Johns, Katherine Gielissen, Thilan Wijesekera, Eric Jordan, Abhishek Karwa, Bethlehem Churnet, David Chia, Katherine Brooks,

Diagnostic Errors in Hospitalized Adults Who Died or Were Transferred to Intensive Care

  • Internal Medicine
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ImportanceDiagnostic errors contribute to patient harm, though few data exist to describe their prevalence or underlying causes among medical inpatients.ObjectiveTo determine the prevalence, underlying cause, and harms of diagnostic errors among hospitalized adults transferred to an intensive care unit (ICU) or who died.Design, Setting, and ParticipantsRetrospective cohort study conducted at 29 academic medical centers in the US in a random sample of adults hospitalized with general medical conditions and who were transferred to an ICU, died, or both from January 1 to December 31, 2019. Each record was reviewed by 2 trained clinicians to determine whether a diagnostic error occurred (ie, missed or delayed diagnosis), identify diagnostic process faults, and classify harms. Multivariable models estimated association between process faults and diagnostic error. Opportunity for diagnostic error reduction associated with each fault was estimated using the adjusted proportion attributable fraction (aPAF). Data analysis was performed from April through September 2023.Main Outcomes and MeasuresWhether or not a diagnostic error took place, the frequency of underlying causes of errors, and harms associated with those errors.ResultsOf 2428 patient records at 29 hospitals that underwent review (mean [SD] patient age, 63.9 [17.0] years; 1107 [45.6%] female and 1321 male individuals [54.4%]), 550 patients (23.0%; 95% CI, 20.9%-25.3%) had experienced a diagnostic error. Errors were judged to have contributed to temporary harm, permanent harm, or death in 436 patients (17.8%; 95% CI, 15.9%-19.8%); among the 1863 patients who died, diagnostic error was judged to have contributed to death in 121 (6.6%; 95% CI, 5.3%-8.2%). In multivariable models examining process faults associated with any diagnostic error, patient assessment problems (aPAF, 21.4%; 95% CI, 16.4%-26.4%) and problems with test ordering and interpretation (aPAF, 19.9%; 95% CI, 14.7%-25.1%) had the highest opportunity to reduce diagnostic errors; similar ranking was seen in multivariable models examining harmful diagnostic errors.Conclusions and RelevanceIn this cohort study, diagnostic errors in hospitalized adults who died or were transferred to the ICU were common and associated with patient harm. Problems with choosing and interpreting tests and the processes involved with clinician assessment are high-priority areas for improvement efforts.

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