Diagnostic errors in patients admitted directly from new outpatient visits

Area of Science:

• Medical error analysis
• Patient safety research
• Diagnostic accuracy studies

Background:

• Diagnostic errors are significant adverse events, particularly in high-pressure settings like rushed handovers.
• Emergency hospitalizations from initial outpatient visits often involve complex cases with more severe diagnostic errors.
• Underreported situations of diagnostic errors in emergency hospitalizations require further investigation.

Purpose of the Study:

• To investigate the incidence and contributing factors of diagnostic errors in patients requiring emergency hospitalization from an outpatient setting.
• To identify specific patient and clinical factors associated with diagnostic errors in this understudied population.

Main Methods:

• Retrospective study of electronic medical records from a Japanese university hospital outpatient clinic.
• Diagnostic errors assessed by two physicians using the Revised Safer Dx instrument.
• Logistic regression and diagnostic error taxonomies (DEER, GDP) used to analyze contributing factors.

Main Results:

• Diagnostic errors were identified in 12.1% of 321 patients.
• Factors associated with errors included involvement of junior residents, male sex, multiple symptoms, and atypical presentations.
• Primary causes were overemphasizing competing diagnoses (DEER) and atypical presentations (GDP).

Conclusions:

• The incidence of diagnostic errors in this emergency hospitalization cohort was higher than previously reported for new outpatient visits.
• Heightened vigilance is crucial for medical residents, especially with patients presenting multiple or atypical symptoms.
• Addressing diagnostic inaccuracies is vital to improve patient safety in outpatient-to-inpatient transitions.