SHM Converge Scientific Abstract ePoster Gallery-Prevalence and Causes of Diagnostic Errors in Patients Hospitalized Under Investigation for Covid-19 Infection

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This retrospective multicenter study examined missed or delayed diagnoses among 258 patients admitted to general medicine units “under investigation” for COVID-19 at eight HOMERuN hospitals between February and July 2021. Using two-physician adjudication and standardized tools (SAFER-DX, NCC-MERP, and DEER taxonomy), the investigators assessed whether diagnostic errors occurred and what process faults contributed.<br /><br />Diagnostic errors were found in 36 patients, a prevalence of 14%. Patients with and without errors looked similar in COVID-19 symptoms, risk factors, and test positivity, suggesting that errors were not explained simply by more severe or more obvious COVID presentations. However, COVID-19 contributed to the error in 22 of the 36 cases (61%).<br /><br />The strongest associations with diagnostic errors were process failures in clinical assessment, physical examination, testing, and communication. In multivariable analysis, physical exam problems and clinical assessment problems showed especially strong links to diagnostic error. Examples of COVID-related process changes included anchoring on COVID as the diagnosis, delayed or incomplete physical exams because of distancing, remote preadmission care, delays in seeking non-COVID care, virtual visits replacing in-person evaluation, and reduced history-taking because of visitor restrictions.<br /><br />The authors concluded that diagnostic errors were common during the early pandemic and were likely influenced by changes in care delivery that affected history-taking, physical examination, and communication. A possible rise in errors over time approached statistical significance and may reflect reopening pressures, workload changes, and shifting team structures.<br /><br />Overall, the study suggests that pandemic-era factors such as distancing, workload, and burnout had meaningful effects on diagnostic quality, and these issues remain relevant for future patient safety research.

Asset Subtitle

Andrew D. Auerbach

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Author List Andrew D. Auerbach, Anunta Virapongse, David Chia, David Sterken, Esteban Gershanik, Farah A. Kaiksow, Gopi J. Astik, Jeffrey L. Schnipper, Jeffrey Rohde, Jigar Contractor, Justin J. Choi, Katie E. Raffel, Kevin J. O'Leary, Li-Kheng Ngov, Molly A. Ka

Category Research

Concept Diagnostic Error

Concept COVID-19

Concept Diagnostic Process

Concept Hospitalization

Concept History Taking

Distinguished Non-Finalist

Presenter Organization University of California, San Francisco

Presenting Author Andrew D. Auerbach

Track Patient Safety

Keywords

diagnostic errors

COVID-19

retrospective multicenter study

general medicine

missed diagnosis

delayed diagnosis

physical examination

clinical assessment

patient safety

pandemic-era care

Diagnostic Error

COVID-19

Diagnostic Process

Hospitalization

History Taking