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Patterns of diagnostic errors using hierarchical cluster analysis: a single-center, cross-sectional study in general
Yuya Suzuki1,2, Toshinori Nishizawa1,3,4, Hiroki Ozawa5
1Department of General Internal Medicine, St Luke's International Hospital, Tokyo, Japan.
Diagnosis (Berlin, Germany)
|April 28, 2026
Summary
Diagnostic errors in outpatient care can be categorized into four failure modes. Understanding these patterns, like prioritization and information synthesis failures, is key to improving patient safety and reducing readmissions.
Area of Science:
- Medical error research
- Patient safety science
- Healthcare quality improvement
Background:
- Diagnostic errors are a significant concern in outpatient settings, influenced by complex factors.
- The specific failure modes of outpatient diagnostic errors remain underexplored, particularly in relation to unexpected readmissions.
Purpose of the Study:
- To explore specific failure modes of outpatient diagnostic errors.
- To examine the causes of unexpected readmissions to identify diagnostic error patterns.
Main Methods:
- Cross-sectional study of outpatients with unexpected readmissions within 14 days of initial visit.
- Independent physician assessment of diagnostic errors using the Revised Safer Dx Instrument and Diagnostic Error Evaluation and Research (DEER) taxonomy.
- Hierarchical clustering of DEER taxonomy and Fisher's exact tests to analyze associations with patient, physician, and system factors.
Main Results:
- 50 out of 146 (34.2%) patients experienced diagnostic errors.
- Two primary failure mode categories identified: diagnostic prioritization/urgency appraisal and information acquisition/synthesis.
- Information synthesis failure included subtypes: data-gathering (PPE use), interpretation (referral letters), and undertesting/safety-netting.
Conclusions:
- Diagnostic errors in outpatient settings can be classified into four distinct failure modes.
- These failure modes correlate with specific DEER taxonomy patterns and contextual factors.
- Identifying these failure modes offers potential targets for enhancing diagnostic safety programs.
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