The Frequency of Diagnostic Errors in Outpatient Care: Estimations From Three Large Observational Studies Involving US Adult Populations

BMJ Qual Saf. 2014 Sep;23(9):727-31. doi: 10.1136/bmjqs-2013-002627. Epub 2014 Apr 17.

Abstract

Background: The frequency of outpatient diagnostic errors is challenging to determine due to varying error definitions and the need to review data across multiple providers and care settings over time. We estimated the frequency of diagnostic errors in the US adult population by synthesising data from three previous studies of clinic-based populations that used conceptually similar definitions of diagnostic error.

Methods: Data sources included two previous studies that used electronic triggers, or algorithms, to detect unusual patterns of return visits after an initial primary care visit or lack of follow-up of abnormal clinical findings related to colorectal cancer, both suggestive of diagnostic errors. A third study examined consecutive cases of lung cancer. In all three studies, diagnostic errors were confirmed through chart review and defined as missed opportunities to make a timely or correct diagnosis based on available evidence. We extrapolated the frequency of diagnostic error obtained from our studies to the US adult population, using the primary care study to estimate rates of diagnostic error for acute conditions (and exacerbations of existing conditions) and the two cancer studies to conservatively estimate rates of missed diagnosis of colorectal and lung cancer (as proxies for other serious chronic conditions).

Results: Combining estimates from the three studies yielded a rate of outpatient diagnostic errors of 5.08%, or approximately 12 million US adults every year. Based upon previous work, we estimate that about half of these errors could potentially be harmful.

Conclusions: Our population-based estimate suggests that diagnostic errors affect at least 1 in 20 US adults. This foundational evidence should encourage policymakers, healthcare organisations and researchers to start measuring and reducing diagnostic errors.

Keywords: Chart Review Methodologies; Diagnostic Errors; Medical Error, Measurement/Epidemiology; Patient Safety; Trigger Tools.

Publication types

  • Observational Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Ambulatory Care / standards
  • Ambulatory Care / statistics & numerical data*
  • Colorectal Neoplasms / diagnosis
  • Colorectal Neoplasms / epidemiology
  • Diagnostic Errors / statistics & numerical data*
  • Humans
  • Lung Neoplasms / diagnosis
  • Lung Neoplasms / epidemiology
  • United States / epidemiology