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. 2024 Jul 5;11(4):400-407.
doi: 10.1515/dx-2024-0041. eCollection 2024 Nov 1.

Diagnostic errors and characteristics of patients seen at a general internal medicine outpatient clinic with a referral for diagnosis

Yumi Otaka  1 , Yukinori Harada  1 , Shinichi Katsukura  1 , Taro Shimizu  1
Affiliations

Diagnostic errors and characteristics of patients seen at a general internal medicine outpatient clinic with a referral for diagnosis

Yumi Otaka et al. Diagnosis (Berl). .

Abstract

Objectives: Patients referred to general internal medicine (GIM) outpatient clinics may face a higher risk of diagnostic errors than non-referred patients. This difference in risk is assumed to be due to the differences in diseases and clinical presentations between referred and non-referred patients; however, clinical data regarding this issue are scarce. This study aimed to determine the frequency of diagnostic errors and compare the characteristics of referred and non-referred patients visit GIM outpatient clinics.

Methods: This study included consecutive outpatients who visited the GIM outpatient clinic at a university hospital, with or without referral. Data on age, sex, chief complaints, referral origin, and final diagnosis were collected from medical records. The Revised Safer Dx Instrument was used to detect diagnostic errors.

Results: Data from 534 referred and 599 non-referred patients were analyzed. The diagnostic error rate was higher in the referral group than that in the non-referral group (2.2 % vs. 0.5 %, p=0.01). The prevalence of abnormal test results and sensory disturbances was higher in the chief complaints, and the prevalence of musculoskeletal system disorders, connective tissue diseases, and neoplasms was higher in the final diagnoses of referred patients compared with non-referred patients. Among referred patients with diagnostic errors, abnormal test results and sensory disturbances were the two most common chief complaints, whereas neoplasia was the most common final diagnosis. Problems with data integration and interpretation were found to be the most common factors contributing to diagnostic errors.

Conclusions: Paying more attention to patients with abnormal test results and sensory disturbances and considering a higher pre-test probability for neoplasms may prevent diagnostic errors in patients referred to GIM outpatient clinics.

Keywords: chief complaints; diagnosis; diagnostic errors; general internal medicine; referral.

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References

    1. Balogh, EP, Miller, BT, Ball, JR, editors. Committee on diagnostic error in health care, board on health care services, Institute of Medicine, the National Academies of Sciences, Engineering, and Medicine. In: Improving diagnosis in health care ; 2015:21794 p. Published Online.
    1. van den Berge, K, Mamede, S. Cognitive diagnostic error in internal medicine. Eur J Intern Med 2013;24:525–9. https://doi.org/10.1016/j.ejim.2013.03.006 . - DOI
    1. Wijesekera, TP, Sanders, L, Windish, DM. Reflections on diagnosis and diagnostic errors: a survey of internal medicine resident and attending physicians. J Gen Intern Med 2020;35:614–5. https://doi.org/10.1007/s11606-019-05045-z . - DOI
    1. Regina, ML, Vecchié, A, Bonaventura, A, Prisco, D. Patient safety in internal medicine. In: Donaldson, L, Ricciardi, W, Sheridan, S, Tartaglia, R, editors. Textbook of patient safety and clinical risk management [Internet] . Cham (CH): Springer; 2021. [Chapter 17]. 2020 dec 15.
    1. Singh, H, Graber, ML. Improving diagnosis in health care-the next imperative for patient safety. N Engl J Med 2015;373:2493–5. https://doi.org/10.1056/nejmp1512241 . - DOI

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