RT Journal Article
SR Electronic
T1 Incidence, origins and avoidable harm of missed opportunities in diagnosis: longitudinal patient record review in 21 English general practices
JF BMJ Quality & Safety
JO BMJ Qual Saf
FD BMJ Publishing Group Ltd
SP 977
OP 985
DO 10.1136/bmjqs-2020-012594
VO 30
IS 12
A1 Sudeh Cheraghi-Sohi
A1 Fiona Holland
A1 Hardeep Singh
A1 Avril Danczak
A1 Aneez Esmail
A1 Rebecca Lauren Morris
A1 Nicola Small
A1 Richard Williams
A1 Carl de Wet
A1 Stephen M Campbell
A1 David Reeves
YR 2021
UL http://qualitysafety.bmj.com/content/30/12/977.abstract
AB Background Diagnostic error is a global patient safety priority.Objectives To estimate the incidence, origins and avoidable harm of diagnostic errors in English general practice. Diagnostic errors were defined as missed opportunities to make a correct or timely diagnosis based on the evidence available (missed diagnostic opportunities, MDOs).Method Retrospective medical record reviews identified MDOs in 21 general practices. In each practice, two trained general practitioner reviewers independently conducted case note reviews on 100 randomly selected adult consultations performed during 2013–2014. Consultations where either reviewer identified an MDO were jointly reviewed.Results Across 2057 unique consultations, reviewers agreed that an MDO was possible, likely or certain in 89 cases or 4.3% (95% CI 3.6% to 5.2%) of reviewed consultations. Inter-reviewer agreement was higher than most comparable studies (Fleiss’ kappa=0.63). Sixty-four MDOs (72%) had two or more contributing process breakdowns. Breakdowns involved problems in the patient–practitioner encounter such as history taking, examination or ordering tests (main or secondary factor in 61 (68%) cases), performance and interpretation of diagnostic tests (31; 35%) and follow-up and tracking of diagnostic information (43; 48%). 37% of MDOs were rated as resulting in moderate to severe avoidable patient harm.Conclusions Although MDOs occurred in fewer than 5% of the investigated consultations, the high numbers of primary care contacts nationally suggest that several million patients are potentially at risk of avoidable harm from MDOs each year. Causes of MDOs were frequently multifactorial, suggesting the need for development and evaluation of multipronged interventions, along with policy changes to support them.Data not included in the article or uploaded as supplementary information is available upon reasonable request.