SHM Converge Scientific Abstract ePoster Gallery-Diagnostic Errors in Patients Admitted Directory From New Outpatient Visits

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This retrospective single-center study examined diagnostic errors (DEs) among patients directly admitted from their first outpatient visit to a general medicine department in Tokyo from 2014 to 2022. Of 898 screened visits, 321 patients met inclusion criteria. Diagnostic errors were identified in 39 cases, yielding a DE rate of 12.1%, which was higher than rates reported in prior outpatient studies.<br /><br />Patients with DEs were more likely to be men, to have more symptoms, to be seen by resident physicians, and to have atypical or uncommon diseases. On multivariable analysis, independent factors associated with DEs included male sex, a greater number of symptoms, involvement of resident physicians, and atypical disease presentation. Atypical presentations showed the strongest association with error.<br /><br />The most common disease category involved in diagnostic errors was infectious disease, especially fever-related presentations. In 21.7% of DE cases, the initial and final diagnostic categories differed. Analysis of error mechanisms using the DEER and Generic Diagnostic Pitfalls frameworks found that the leading cause was excessive weighting of competing or coexisting diagnoses, followed by failure to appreciate limitations of tests and atypical presentations, as well as overlooked counter-diagnostic clues.<br /><br />The study concludes that direct admissions from new outpatient visits are a high-risk setting for diagnostic errors, particularly when patients present with multiple or atypical symptoms and when resident physicians are involved. The authors recommend heightened diagnostic vigilance, broader differential diagnosis, and support tools to reduce premature closure and improve diagnostic accuracy.

Asset Subtitle

Taiju Miyagami

Meta Tag

Author List Taiju Miyagami, Taro Shimizu, Toshio Naito, Yu Watanabe

Category Research

Concept Diagnostic Error

Concept Diagnostic Error Rate

Concept Atypical Presentation

Concept Competing Diagnosis

Concept Missed Red Flag

Distinguished Non-Finalist

Presenter Organization Department of General Medicine, Faculty of Medicine, Juntendo University

Presenting Author Taiju Miyagami

Track Transitions of Care

Keywords

diagnostic errors

outpatient visits

general medicine

retrospective study

Tokyo

resident physicians

atypical presentation

infectious disease

fever

diagnostic pitfalls

Diagnostic Error

Diagnostic Error Rate

Atypical Presentation

Competing Diagnosis

Missed Red Flag