Potential Diagnostic Error for Emergency Conditions, Mortality, and Healthy Days at Home

Area of Science:

• Emergency Medicine
• Health Services Research
• Patient Safety

Background:

• Limited evidence exists on diagnostic error frequency and outcomes in US emergency care.
• Understanding these errors is crucial for improving patient safety and healthcare quality.

Purpose of the Study:

• To determine the rates of potential diagnostic errors in emergency departments (EDs).
• To examine the clinical outcomes, including mortality and healthy days at home, associated with these errors among Medicare beneficiaries.

Main Methods:

• A cohort study analyzed fee-for-service Medicare beneficiaries aged 65+ hospitalized for 10 high-risk conditions (2016-2019).
• Potential diagnostic errors were identified as ED discharges within 9 days prior to hospitalization.
• Multivariable linear regression models assessed the association between diagnostic errors and 30-day mortality and healthy days at home (HDAH).

Main Results:

• An adjusted potential diagnostic error rate of 3.2% was found across all conditions, with significant variation by condition (2.1% to 15.6%).
• Potential diagnostic errors were linked to increased 30-day mortality (15.7% vs 14.9%) and fewer HDAH (13.5 vs 15.0 days).
• Associations between errors and outcomes varied across different medical conditions.

Conclusions:

• The adjusted rate of potential diagnostic errors in emergency hospitalizations is modest overall but condition-dependent.
• Potential diagnostic errors are associated with adverse outcomes, including higher mortality and reduced HDAH.
• These findings underscore the need for targeted interventions to reduce diagnostic errors in emergency care.