Diagnostic errors in patients admitted directly from new outpatient visits

Abstract

Objectives: Diagnostic errors frequently represent significant adverse events that can occur in any medical setting, particularly in rushed handovers and constrained timing. Cases that result in emergency hospitalization at the time of the initial outpatient visit are more likely to have complex or serious patient conditions and more detrimental diagnostic errors. Our study investigated diagnostic errors in these under reported situations.

Methods: We conducted a retrospective study using electronic medical record data on patients who were directly admitted to a newly established outpatient clinic at a single university hospital in Japan. Diagnostic errors were assessed independently by two physicians using the Revised Safer Dx instrument. We analyzed patient demographics, symptoms, referrals, and resident doctor (postgraduate-year-1) involvement using logistic regression to compare groups with and without diagnostic error. Additionally, we employed the Diagnostic Error Evaluation and Research (DEER) taxonomy and Generic Diagnostic Pitfalls (GDP) to examine the factors associated with diagnostic errors.

Results: The study included 321 patients, with diagnostic errors identified in 39 cases (12.1 %). Factors contributing to diagnostic errors included the involvement of young residents, male patients, the number of symptoms, and atypical presentation. The most common causes of diagnostic errors were "too much weight given to competing/coexisting diagnosis" as indicated by DEER and "atypical presentation" by GDP.

Conclusions: The frequency of diagnostic errors in this study was higher than those in previous studies of new outpatient visits, underscoring the imperative for heightened scrutiny in cases involving medical residents especially when patients present with multiple or atypical symptoms. This vigilance is crucial to mitigating the risk of diagnostic inaccuracies in these settings. Cases that result in emergency hospitalization at the time of the initial outpatient visit are more likely to have complex or serious patient conditions and more detrimental diagnostic errors.

Keywords: diagnostic error; education; recognition.