Medicine, University of California San Francisco, San Francisco, California, USA
Medicine, University of California San Francisco, San Francisco, California, USA.
BMJ Qual Saf. 2020 Dec;29(12):971-979. doi: 10.1136/bmjqs-2020-010896. Epub 2020 Aug 4.
The prevalence and aetiology of diagnostic error among hospitalised adults is unknown, though likely contributes to patient morbidity and mortality. We aim to identify and characterise the prevalence and types of diagnostic error among patients readmitted within 7 days of hospital discharge.
Retrospective cohort study at a single urban academic hospital examining adult patients discharged from the medical service and readmitted to the same hospital within 7 days between January and December 2018. The primary outcome was diagnostic error presence, identified through two-physician adjudication using validated tools. Secondary outcomes included severity of error impact and characterisation of diagnostic process failures contributing to error.
There were 391 cases of unplanned 7-day readmission (5.2% of 7507 discharges), of which 376 (96.2%) were reviewed. Twenty-one (5.6%) admissions were found to contain at least one diagnostic error during the index admission. The most common problem areas in the diagnostic process included failure to order needed test(s) (n=11, 52.4%), erroneous clinician interpretation of test(s) (n=10, 47.6%) and failure to consider the correct diagnosis (n=8, 38.1%). Nineteen (90.5%) of the diagnostic errors resulted in moderate clinical impact, primarily due to short-term morbidity or contribution to the readmission.
The prevalence of diagnostic error among 7-day medical readmissions was 5.6%. The most common drivers of diagnostic error were related to clinician diagnostic reasoning. Efforts to reduce diagnostic error should include strategies to augment diagnostic reasoning and improve clinician decision-making around diagnostic studies.
住院成年人的诊断错误的患病率和病因尚不清楚，但可能导致患者发病率和死亡率升高。我们旨在确定并描述在出院后 7 天内再次入院的患者中诊断错误的患病率和类型。
这是一项在单家城市学术医院进行的回顾性队列研究，研究对象为 2018 年 1 月至 12 月期间从内科出院并在出院后 7 天内再次入住同一医院的成年患者。主要结局是通过使用经过验证的工具进行两位医生的裁决来确定诊断错误的存在。次要结局包括错误影响的严重程度以及导致错误的诊断过程失败的特征。
共有 391 例计划外的 7 天内再入院（占 7507 例出院人数的 5.2%），其中 376 例（96.2%）接受了审查。在索引入院期间，有 21 例（5.6%）入院被发现至少存在一项诊断错误。诊断过程中最常见的问题领域包括未能开出所需的检查（n=11，52.4%）、临床医生错误地解释检查结果（n=10，47.6%）和未能考虑正确的诊断（n=8，38.1%）。19 项（90.5%）诊断错误导致中度临床影响，主要是由于短期发病率或导致再次入院。
7 天内内科再入院的诊断错误发生率为 5.6%。诊断错误的最常见驱动因素与临床医生的诊断推理有关。减少诊断错误的努力应包括增强诊断推理和改善临床医生围绕诊断研究的决策制定的策略。
