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New Malpractice Research Probes Misdiagnosis and Serious Patient Harm

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July 12, 2019

According to new research* from Johns Hopkins University School of Medicine and CRICO Strategies, 1-in-3 malpractice cases with serious patient harm is due to misdiagnosis. Specifically, findings showed 74 percent of inaccurate or delayed diagnoses that result in permanent disability or death are attributable to three disease categories: cancer, vascular events, and infections.

Researchers analyzed more than 400,000 malpractice claims drawn from more than 400 academic and community medical centers—an estimated 30 percent of all malpractice claims in the United States. The study examined approximately 55,000 malpractice claims to determine how many were attributable to diagnostic error.

Of malpractice claims attributable to diagnostic error, researchers reviewed underlying disease states to identify patterns of misdiagnosis. They found that of the diagnostic errors causing the most harm, three quarters (74.1 percent) are attributable to just three categories of conditions: cancer (37.8 percent), vascular events (22.8 percent), and infection (13.5 percent). These severe cases resulted in $1.8 billion in malpractice payouts over 10 years. The authors also showed that, collectively, the top 5 in each category account for nearly half (47.1 percent) of all the serious harms.

"For many patients, misdiagnosis causes severe harm and expense, and in the worst cases, death," said David Newman-Toker, MD, PhD, professor of neurology at the Johns Hopkins University School of Medicine and director of the Johns Hopkins Armstrong Institute for Patient Safety and Quality Center for Diagnostic Excellence, who served as lead author of the research.

He continued, "This study shows us where to focus to start making a difference for patients. It tells us that tackling diagnosis in these three specific disease areas could have a major impact on reducing misdiagnosis-related harms."

The research confirms that inaccurate or delayed diagnosis remains the most common, most catastrophic, and most costly of medical errors. The analysis provides additional context for a 2015 National Academy of Medicine report that highlighted that diagnostic errors result in up to 80,000 deaths annually in US hospitals.

Dana Siegal, RN, CPHRM, CPPS, director of patient safety for CRICO Strategies, said, "The insights gained from this new research will help organizations know where to direct their focus to improve the diagnostic process of care."

An inaccurate or delayed diagnosis is about the complete care delivery process and associated with all members of the healthcare team, including patients. It will take system-wide efforts, and study authors also noted that research and quality improvement efforts need to focus on interventions in the specific practice settings where the harm occurs such as "stroke in the emergency department, sepsis in the hospital, and lung cancer in primary care."

* The new research appears in the peer-reviewed journal, Diagnosis, and was funded by the Society to Improve Diagnosis in Medicine (SIDM) through a grant from the Gordon and Betty Moore Foundation.

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