Patient record review of the incidence, consequences, and causes of diagnostic adverse events.
BACKGROUND
Diagnostic errors often result in patient harm. Previous studies have shown that there is large variability in results in different medical specialties. The present study explored diagnostic adverse events (DAEs) across all medical specialties to determine their incidence and to gain insight into their causes and consequences by comparing them with other AE types.


METHODS
A structured review study of 7926 patient records was conducted. Randomly selected records were reviewed by trained physicians in 21 hospitals across the Netherlands. The method used in this study was based on the well-known protocol developed by the Harvard Medical Practice Study. All AEs with diagnostic error as the main category were selected for analysis and were compared with other AE types.


RESULTS
Diagnostic AEs occurred in 0.4% of hospital admissions and represented 6.4% of all AEs. Of the DAEs, 83.3% were judged to be preventable. Human failure was identified as the main cause (96.3%), although organizational- and patient-related factors also contributed (25.0% and 30.0%, respectively). The consequences of DAEs were more severe (higher mortality rate) than for other AEs (29.1% vs 7.4%).


CONCLUSIONS
Diagnostic AEs represent an important error type, and the consequences of DAEs are severe. The causes of DAEs were mostly human, with the main causes being knowledge-based mistakes and information transfer problems. Prevention strategies should focus on training physicians and on the organization of knowledge and information transfer.
Zwaan
Laura
L
Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands. Laura.zwaan@vumc.nl
de Bruijne
Martine
M
Wagner
Cordula
C
Thijs
Abel
A
Smits
Marleen
M
van der Wal
Gerrit
G
Timmermans
Daniëlle R M
DR
D003951:Diagnostic Errors / Q000517:prevention & control / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006753:Hospital Records / Q000706:statistics & numerical data*; D006801:Humans; D007049:Iatrogenic Disease / Q000453:epidemiology* / Q000517:prevention & control; D015994:Incidence; D008485:Medical Audit / Q000379:methods; D009426:Netherlands / Q000453:epidemiology; D010343:Patient Admission; D010344:Patient Advocacy; D012189:Retrospective Studies; D017751:Safety Management / Q000592:standards*