New research from Coverys, a medical liability insurer headquartered in Boston, found diagnosis-related errors and failures are the biggest cause of claims. They make up 33 percent of all claims and 47 percent of indemnity payments.
Coverys analyzed 10,618 closed medical professional liability claims from 2013 to 2017.
Titled Diagnostic Accuracy: Room for Improvement, the report also found 54 percent of diagnosis-related claims are high severity cases, and 36 percent of them end in death. Plus, 53 percent of diagnostic-related claims encompass risk management issues involving poor clinical decision-making.
Robert Hanscom, Coverys’ vice president of business analytics and an author of the report, elaborated on this last point.
“Diagnosis-related claims are most frequently cancers, and often relate to acts of omission — rather than the highly visible missteps that we might see in the worlds of surgery, medication error, etc.,” he said via email.
Of the 3,466 diagnosis-related claims analyzed, 27 percent involved cancer. Infections (13 percent), cardiac/vascular conditions (8 percent), fractures/dislocations (5 percent) and myocardial infarctions (4 percent) were other top conditions involved in such claims.
Diagnosing a patient involves a complex assortment of various steps and processes. This can cause experienced physicians to make mistakes, and it can show that some physicians aren’t following the correct protocol and cognitive principles, Hanscom added.
Such mistakes can result in big problems for the clinician.
“Often, the first time a physician is made aware that he/she missed a diagnosis is when papers are served,” Hanscom said. “By that time, they have little memory of the encounter in question — and sometimes scant memory of the actual patient (who may have subsequently sought care elsewhere). Bottom line, there is a dearth of data and ‘intelligence’ as to where the care went off track, and very little from which physicians can learn.”
However, physicians and health systems can take certain steps to reduce diagnostic errors.
For one, they can invest in EHR features that more clearly display a patient’s clinical history. This information, as well as test results and referrals to specialists, should be “front and center” in the EHR, Hanscom said.
Additionally, any uncertainty in a diagnosis should be noted in the EHR. “If it is not, as more and more clinicians subsequently treat the patient, that diagnosis will become cast as definite — when, in fact, it was anything but,” Hanscom said.
Decision support tools are also crucial in assisting clinicians as they seek to uncover other potential diagnoses for a patient.
Patients can help as well. Physicians can train them to report whether their symptoms worsen, remain the same or improve.
Photo: HASLOO, Getty Images
