• Posted July 20, 2023

New Report Measures Scope of Damage From Medical Mistakes

About 795,000 Americans die or are permanently disabled every year due to misdiagnosed medical conditions.

A new analysis led by experts at Johns Hopkins Medicine in Baltimore looks more closely at diagnostic error and its impact.

“Prior work has generally focused on errors occurring in a specific clinical setting, such as primary care, the emergency department or hospital-based care,” lead author Dr. David Newman-Toker, director of the Center for Diagnostic Excellence, said in a Hopkins news release.

“These studies could not address the total serious harms across multiple care settings, the previous estimates of which varied widely from 40,000 to 4 million per year. The methods used in our study are notable because they leverage disease-specific error and harm rates to estimate an overall total,” he added.

The researchers, from Johns Hopkins and the Risk Management Foundation of the Harvard Medical Institutions, looked at 15 diseases and concluded that 371,000 Americans died and 424,000 were permanently disabled as a result of misdiagnoses.

About 75% of the serious harms happen in connection with vascular events, infections and cancers. In all, 15 diseases account for nearly 51% of the serious harms.

Five conditions — stroke, sepsis, pneumonia, venous thromboembolism and lung cancer — cause nearly 39% of total serious harms.

Across diseases, the overall average error rate was estimated at 11%, but the rate ranges widely — from 1.5% for heart attack to 62% for spinal abscess. Stroke was the top cause of serious harm from misdiagnosis, found in 17.5% of cases.

Diseases with high error rates should be top priority targets for solutions, the authors said.

“A disease-focused approach to diagnostic error prevention and mitigation has the potential to significantly reduce these harms,” Newman-Toker said. “Reducing diagnostic errors by 50% for stroke, sepsis, pneumonia, pulmonary embolism and lung cancer could cut permanent disabilities and deaths by 150,000 per year.”

Johns Hopkins has already developed and started using solutions to address missed stroke cases, he said.

Solutions include virtual patient simulators to improve the skills of front-line clinicians, as well as portable eye movement recordings via video goggles and mobile phones to enable specialists to remotely assist clinicians in diagnosing stroke. They also include computer-based algorithms to automate parts of the diagnostic process and dashboards that measure performance and provide feedback on quality improvement.

“Funding for these efforts remains a barrier,” Newman-Toker said. “Diagnostic errors are, by a wide margin, the most under-resourced public health crisis we face, yet research funding only recently reached the $20 million per year mark. If we are to achieve diagnostic excellence and the goal of zero preventable harm from diagnostic error, we must continue to invest in efforts to achieve success.”

The study findings were published July 17 in BMJ Quality & Safety.

More information

The U.S. National Institutes of Health has more on stroke diagnosis.

SOURCE: Johns Hopkins Medicine, news release, July 17, 2023