Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
J Gen Intern Med. 2023 Jun;38(8):1902-1910. doi: 10.1007/s11606-023-08176-6. Epub 2023 Mar 23.
The COVID-19 pandemic required clinicians to care for a disease with evolving characteristics while also adhering to care changes (e.g., physical distancing practices) that might lead to diagnostic errors (DEs).
To determine the frequency of DEs and their causes among patients hospitalized under investigation (PUI) for COVID-19.
Retrospective cohort.
Eight medical centers affiliated with the Hospital Medicine ReEngineering Network (HOMERuN).
Adults hospitalized under investigation (PUI) for COVID-19 infection between February and July 2020.
We randomly selected up to 8 cases per site per month for review, with each case reviewed by two clinicians to determine whether a DE (defined as a missed or delayed diagnosis) occurred, and whether any diagnostic process faults took place. We used bivariable statistics to compare patients with and without DE and multivariable models to determine which process faults or patient factors were associated with DEs.
Two hundred and fifty-seven patient charts underwent review, of which 36 (14%) had a diagnostic error. Patients with and without DE were statistically similar in terms of socioeconomic factors, comorbidities, risk factors for COVID-19, and COVID-19 test turnaround time and eventual positivity. Most common diagnostic process faults contributing to DE were problems with clinical assessment, testing choices, history taking, and physical examination (all p < 0.01). Diagnostic process faults associated with policies and procedures related to COVID-19 were not associated with DE risk. Fourteen patients (35.9% of patients with errors and 5.4% overall) suffered harm or death due to diagnostic error.
Results are limited by available documentation and do not capture communication between providers and patients.
Among PUI patients, DEs were common and not associated with pandemic-related care changes, suggesting the importance of more general diagnostic process gaps in error propagation.
COVID-19 大流行要求临床医生在治疗一种具有不断变化特征的疾病的同时，还要遵守可能导致诊断错误（DE）的护理变化（例如，身体距离实践）。
确定在因 COVID-19 接受调查（PUI）住院的患者中 DE 的频率及其原因。
回顾性队列研究。
隶属于医院医学再工程网络（HOMERuN）的 8 个医疗中心。
2020 年 2 月至 7 月期间因 COVID-19 感染而接受调查（PUI）住院的成年人。
我们每个月随机选择每个地点最多 8 例进行审查，每例由两名临床医生进行审查，以确定是否发生 DE（定义为漏诊或延迟诊断），以及是否发生任何诊断过程错误。我们使用双变量统计来比较有和没有 DE 的患者，并使用多变量模型来确定哪些诊断过程错误或患者因素与 DE 相关。
257 份患者病历进行了审查，其中 36 份（14%）有诊断错误。有和没有 DE 的患者在社会经济因素、合并症、COVID-19 危险因素以及 COVID-19 检测周转时间和最终阳性率方面无统计学差异。导致 DE 的最常见诊断过程错误是临床评估、检测选择、病史采集和体格检查方面的问题（均 p < 0.01）。与 COVID-19 相关政策和程序相关的诊断过程错误与 DE 风险无关。14 名患者（错误患者的 35.9%和总体的 5.4%）因诊断错误而遭受伤害或死亡。
结果受到可用文档的限制，并且无法捕获提供者和患者之间的沟通。
在 PUI 患者中，DE 很常见，与大流行相关的护理变化无关，这表明在错误传播中更普遍的诊断过程差距的重要性。
