SHM Converge Scientific Abstract ePoster Gallery-Diagnostic Process Failure Points Associated With Diagnostic Failure in the Hospital

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This study examined how specific diagnostic process failures (DPFs) are associated with diagnostic error (DE) in hospitalized general medicine patients. Using secondary chart review data from 349 cases (113 DE-positive and 236 DE-negative) drawn from a stratified sample of 4,715 hospitalizations, the authors analyzed 41 possible DPFs across 8 DEER Taxonomy domains.<br /><br />Overall, diagnostic errors were linked to substantially more process failures. DE-positive cases had a weighted mean of 4.66 DPFs versus 0.89 in DE-negative cases, with an overall weighted odds ratio of 2.68. Significant associations were seen in 6 of the 8 domains, especially:<br />- Physical exam and assessment (wOR 8.56)<br />- History (wOR 6.41)<br />- Diagnostic test ordering, performance, and interpretation (wOR 5.30)<br />- Diagnostic information and patient follow-up (wOR 3.59)<br />- Subspecialty consultation/referral (wOR 3.74)<br />- Access/presentation (wOR 2.61)<br /><br />The most frequent individual failures were suboptimal weighing of history, failure or delay in ordering needed tests, and failure to recognize or act on urgent conditions or complications. Other common problems included poor weighting of physical exam findings, suboptimal consultation, and communication gaps within the healthcare team.<br /><br />The findings suggest high-yield targets for intervention to reduce diagnostic error, particularly improving history-taking, physical exam interpretation, test ordering and interpretation, and follow-up on concerning findings. Limitations include reliance on documented chart review rather than informal communication, a small cohort, exclusion of long stays over 21 days, and data from a single academic medical center.

Asset Subtitle

Kaitlyn A. Konieczny

Meta Tag

Author List Alyssa Lam, Anuj K. Dalal, Bashar Kasabchy, Cathy Yoon, Daniel Motta-Calderon, Jeffrey L. Schnipper, Kaitlyn A. Konieczny, Kevin Carr, Savanna Plombon, Stuart Lipsitz

Category Research

Concept Diagnostic Error

Concept Diagnostic Process Failure

Concept History

Concept Physical Examination

Concept Diagnostic Testing

Distinguished Non-Finalist

Presenter Organization Brigham and Women's Hospital

Presenting Author Kaitlyn A. Konieczny

Track Patient Safety

Keywords

diagnostic error

diagnostic process failures

hospitalized patients

general medicine

chart review

history-taking

physical examination

test ordering

patient follow-up

subspecialty consultation

Diagnostic Error

Diagnostic Process Failure

History

Physical Examination

Diagnostic Testing