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Giardina T, Menon S, Haskell H, Hallisy J, Southwick F, Sarkar U, Singh H. An Exploration of Patient and Family Self-Reports of Diagnostic Errors. Paper presented at: Diagnostic Error in Medicine Annual International Conference; 2016 Nov 7; Hollywood, CA.
Background: Although comprehensive reporting could help understand the origin, impact and prevention of diagnostic errors, existing reporting systems only capture a fraction of errors. Reports from patients can provide valuable insight into safety-related problems. We conducted a descriptive analysis of patient- and family-reported diagnostic error narratives to understand factors that contribute to those errors. Methods: Our study sample included patient- and family-reported adverse medical events submitted to a surveybased online reporting platform housed by the Empowered Patient Coalition (EPC) between January 2010 and February 2016. Patients, family members and caregivers submitted data to report their care experiences via structured data and free text. We conducted a qualitative content analysis of all cases of self-reported diagnostic errors with written narratives of patient experiences. Diagnostic error narratives were coded by two coders, merged and discussed to identify major themes. Data analysis is ongoing. Results: Of the 100 cases analyzed thus far in this study, 63.0% involved female patients; 94.0% resided in the United States, and average age was 45.5 (range 1 week to 87 years old). The types of diagnostic errors experienced included: 77.0% delay in diagnosis or treatment, 63.0% misdiagnosis, 46.0% proper test not ordered, 31.0% test results lost, misplaced or disregarded, and 9.0% laboratory or pathology error. Forty eight of the respondents included a narrative specifically about a diagnostic error. Analysis of those narratives revealed the diagnostic testing process to be particularly problematic across many of the stories (n = 30, 62.5%). Respondents reported incidents related to ordering of tests (e.g., failure or refusal to order or ordering inappropriate tests); communication of test results (e.g., failure or delay in communication); and interpretation of test results (e.g., misreading of tests). Table 1 provides illustrative quotes. Many of these process breakdowns were attributed to communication issues such as failure to listen to patients or failure to discuss testing decisions. Respondents indicated a sense of frustration when physicians made final decisions about testing without discussion or incorporating patient preferences. In some cases, respondents indicated they sought a second opinion to obtain necessary testing and diagnosis. Conclusion: Among patient- and family-reported diagnostic errors, diagnostic testing issues are prominent and emerge when physicians fail to listen to patients or fail to discuss testing-related decisions. Our findings highlight the need to augment the use of patient-centered communication and shared decision-making principles to facilitate decisions that are made alongside patients, families and caregivers rather than for them.