Diagnostic errors in ambulatory care: dimensions and preventive strategies
- 282 Downloads
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.
KeywordsDiagnostic error Ambulatory care Primary care Diagnostic tests Electronic communication Patient behaviors Patient follow-up
Dr. Singh is supported in part by the Houston VA HSR&D Center of Excellence (HFP90-020).
- 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
- 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
- Redelmeier, D. A. (2005). Improving patient care. The cognitive psychology of missed diagnoses. Annals of Internal Medicine, 142, 115–120.Google Scholar
- Rosenthal, M. M., & Sutcliffe, K. M. (2002). Medical error: What do we know, What do we do? Hoboken, NJ: Wiley.Google Scholar