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Advances in Health Sciences Education

, Volume 14, Supplement 1, pp 57–61 | Cite as

Diagnostic errors in ambulatory care: dimensions and preventive strategies

  • Hardeep Singh
  • Saul N. Weingart
ORIGINAL PAPER

Abstract

Despite an increasing focus on patient safety in ambulatory care, progress in understanding and reducing diagnostic errors in this setting lag behind many other safety concerns such as medication errors. To explore the extent and nature of diagnostic errors in ambulatory care, we identified five dimensions of ambulatory care from which errors may arise: (1) the provider–patient encounter, (2) performance and interpretation of diagnostic tests, (3) follow-up of patients and diagnostic test results, (4) subspecialty consultation, and (5) patients seeking care and adhering to their instruction/appointments, i.e. patient behaviors. We presented these risk domains to conference participants to elicit their views about sources of and solutions to diagnostic errors in ambulatory care. In this paper, we present a summary of discussion in each of these risk domains. Many novel themes and hypotheses for future research and interventions emerged.

Keywords

Diagnostic error Ambulatory care Primary care Diagnostic tests Electronic communication Patient behaviors Patient follow-up 

Notes

Acknowledgments

Dr. Singh is supported in part by the Houston VA HSR&D Center of Excellence (HFP90-020).

References

  1. Aiello Bowles, E. J., Tuzzio, L., Wiese, C. J., et al. (2008). Understanding high-quality cancer care: A summary of expert perspectives. Cancer, 112, 934–942.CrossRefGoogle Scholar
  2. Gandhi, T. K., Kachalia, A., Thomas, E. J., et al. (2006). Missed and delayed diagnoses in the ambulatory setting: A study of closed malpractice claims. Annals of Internal Medicine, 145, 488–496.Google Scholar
  3. Graber, M. L., Franklin, N., & Gordon, R. (2005). Diagnostic error in internal medicine. Archives of Internal Medicine, 165, 1493–1499.CrossRefGoogle Scholar
  4. Langenbach, M. R., Schmidt, J., Neumann, J., & Zirngibl, H. (2003). Delay in treatment of colorectal cancer: Multifactorial problem. World Journal of Surgery, 27, 304–308.CrossRefGoogle Scholar
  5. Phillips, R. L., Jr., Bartholomew, L. A., Dovey, S. M., Fryer, G. E., Jr., Miyoshi, T. J., & Green, L. A. (2004). Learning from malpractice claims about negligent, adverse events in primary care in the United States. Quality & Safety in Health Care, 13, 121–126.CrossRefGoogle Scholar
  6. Rayson, D., Chiasson, D., & Dewar, R. (2004). Elapsed time from breast cancer detection to first adjuvant therapy in a Canadian province, 1999–2000. CMAJ, 170, 957–961.Google Scholar
  7. Redelmeier, D. A. (2005). Improving patient care. The cognitive psychology of missed diagnoses. Annals of Internal Medicine, 142, 115–120.Google Scholar
  8. Rosenthal, M. M., & Sutcliffe, K. M. (2002). Medical error: What do we know, What do we do? Hoboken, NJ: Wiley.Google Scholar
  9. Schiff, G. D. (1994). Commentary: Diagnosis tracking and health reform. American Journal of Medical Quality, 9, 149–152.CrossRefGoogle Scholar
  10. Singh, H., Arora, H. S., Vij, M. S., Rao, R., Khan, M., & Petersen, L. A. (2007a). Communication outcomes of critical imaging results in a computerized notification system. Journal of the American Medical Informatics Association, 14, 459–466.CrossRefGoogle Scholar
  11. Singh, H., Naik, A., Rao, R., & Petersen, L. (2008). Reducing diagnostic errors through effective communication: Harnessing the power of information technology. Journal of General Internal Medicine, 23, 489–494.CrossRefGoogle Scholar
  12. Singh, H., Petersen, L. A., & Thomas, E. J. (2006). Understanding diagnostic errors in medicine: A lesson from aviation. Quality & Safety in Health Care, 15, 159–164.CrossRefGoogle Scholar
  13. Singh, H., Sethi, S., Raber, M., & Petersen, L. A. (2007b). Errors in cancer diagnosis: Current understanding and future directions. Journal of Clinical Oncology, 25, 5009–5018.CrossRefGoogle Scholar
  14. Singh, H., Thomas, E. J., Khan, M., & Petersen, L. A. (2007c). Identifying diagnostic errors in primary care using an electronic screening algorithm. Archives of Internal Medicine, 167, 302–308.CrossRefGoogle Scholar
  15. Wahls, T. L., & Cram, P. M. (2007). The frequency of missed test results and associated treatment delays in a highly computerized health system. BMC Family Practice, 8, 32.CrossRefGoogle Scholar
  16. Weingart, S. N., Wilson, R. M., Gibberd, R. W., & Harrison, B. (2000). Epidemiology of medical error. BMJ, 320, 774–777.CrossRefGoogle Scholar
  17. Woods, D. M., Thomas, E. J., Holl, J. L., Weiss, K. B., & Brennan, T. A. (2007). Ambulatory care adverse events and preventable adverse events leading to a hospital admission. Quality and Safety in Healthcare, 16(2), 127–131.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2009

Authors and Affiliations

  1. 1.Houston VA HSR&D Center of Excellence, The Center of Inquiry to Improve Outpatient Safety Through Effective Electronic CommunicationMichael E. DeBakey Veterans Affairs Medical Center (152)HoustonUSA
  2. 2.Section of Health Services Research, Department of MedicineBaylor College of MedicineHoustonUSA
  3. 3.Center for Patient SafetyDana-Farber Cancer Institute and Harvard Medical SchoolBostonUSA

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