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The challenges in defining and measuring diagnostic error
Open accessAbstract
Diagnostic errors have emerged as a serious patient safety problem but they are hard to detect and complex to define. At the research summit of the 2013 Diagnostic Error in Medicine 6th International Conference, we convened a multidisciplinary expert panel to discuss challenges in defining and measuring diagnostic errors in real-world settings. In this paper, we synthesize these discussions and outline key research challenges in operationalizing the definition and measurement of diagnostic error. Some of these challenges include 1) difficulties in determining error when the disease or diagnosis is evolving over time and in different care settings, 2) accounting for a balance between underdiagnosis and overaggressive diagnostic pursuits, and 3) determining disease diagnosis likelihood and severity in hindsight. We also build on these discussions to describe how some of these challenges can be addressed while conducting research on measuring diagnostic error.
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“The complexity of defining and quantifying diagnostic error shows that this area is largely overlooked in the field of patient safety when compared to other quality concerns, including infection, wrong-site surgery, and adverse drug events [4,6,7].”
From Toward Safer Diagnoses: A SEIPS-Based Narrative Review of Diagnostic Errors (2026) · cites this paper as [4]
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“The unpredictable and evolving nature of disease conditions makes diagnostic safety more challenging to address [4] than other healthcare safety issues, such as medication and surgical errors [1,5].”
From Toward Safer Diagnoses: A SEIPS-Based Narrative Review of Diagnostic Errors (2026) · cites this paper as [4]
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Metadata
- Authors
- Zwaan, L., & Singh, H.
- Affiliations
- Michael E. DeBakey VA Medical Center (US)
- Corresponding author
- Zwaan, Laura
- Venue
- Diagnosis
- Publisher
- Walter de Gruyter GmbH
- Published
- 2015-03-12
- Volume
- 2
- Issue
- 2
- Pages
- 97-103
- ISSN
- 2194-8011 (ISSN-L)
- 2194-802X
- PMC
- PMC4779119
- OpenAlex
- W2062974444
- Cited by
- 173
- References
- 47
- Citations by year
- 2026: 10 · 2025: 16 · 2024: 16 · 2023: 18 · 2022: 19 · 2021: 25 · 2020: 15 · 2019: 14 · 2018: 14 · 2017: 11 · 2016: 9 · 2015: 6
- FWCI
- 15.57
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Diagnosis (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (publishedVersion)
- PubMed Central (acceptedVersion, cc-by)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Funders
- Agency for Healthcare Research and Quality (R13HS021774, R01HS022087)
- National Cancer Institute (K23CA125585)
- Topics
- Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Patient Safety and Medication Errors
- Health Sciences › Health Professions › Medical Laboratory Technology › Clinical Laboratory Practices and Quality Control
- Keywords
- diagnostic errors, patient safety, underdiagnosis, retrospective diagnosis
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