Characterizing Diagnostic Error in Referrals to an Academic Cornea and External Disease Practice

Area of Science:

• Ophthalmology
• Medical Diagnostics
• Patient Safety

Background:

• Diagnostic errors occur in various medical specialties.
• Referrals to subspecialties like cornea and external disease are susceptible to diagnostic inaccuracies.
• Understanding the characteristics of these errors is crucial for improving patient outcomes.

Purpose of the Study:

• To systematically describe the characteristics of diagnostic errors in referrals to ophthalmology's cornea and external disease subspecialty.
• To analyze patterns, pitfalls, and causes of diagnostic errors.
• To evaluate the impact of ambiguous diagnostic language on diagnosis and treatment timelines.

Main Methods:

• Retrospective analysis of 118 new patient referrals to an academic cornea clinic.
• Extracted diagnoses from referring and referral providers.
• Utilized the Diagnosis Error Evaluation and Research (DEER) Taxonomy to categorize errors.
• Analyzed error types, causes, naming ambiguity, and time to diagnosis/treatment.

Main Results:

• A significant diagnostic error rate of 42% was identified.
• Ambiguous diagnostic terminology (DA) accounted for 51% of diagnostic errors.
• Both DA and traditional diagnostic errors (DE) led to similar delays in diagnosis and treatment.
• Common errors included missed ocular neuropathic pain and exposure keratopathy.
• All errors stemmed from failures in history-taking or physical examination.

Conclusions:

• Diagnostic errors in cornea referrals predominantly originate from history-taking or physical examination deficiencies.
• Ambiguous diagnostic language is a significant contributor to diagnostic error, causing treatment delays comparable to outright misdiagnosis.
• Targeting cognitive biases in ophthalmology training is a potential strategy to mitigate diagnostic errors and improve patient care.