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Cited by 662Clinical Reasoning and Diagnostic SkillsMedical Malpractice and Liability IssuesPatient Safety and Medication Errors

The DOI matches its Crossref record; 33 of the 36 references it cites were found in a registry or an index.

Missed and Delayed Diagnoses in the Ambulatory Setting: A Study of Closed Malpractice Claims

Gandhi, Tejal K., Kachalia, Allen, Thomas, Eric J., Puopolo, Ann Louise, Yoon, Catherine, Brennan, Troyen A., Studdert, David M.·2006·Annals of Internal Medicine
DOI 10.7326/0003-4819-145-7-200610030-00006
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Abstract

BACKGROUND: Although missed and delayed diagnoses have become an important patient safety concern, they remain largely unstudied, especially in the outpatient setting. OBJECTIVE: To develop a framework for investigating missed and delayed diagnoses, advance understanding of their causes, and identify opportunities for prevention. DESIGN: Retrospective review of 307 closed malpractice claims in which patients alleged a missed or delayed diagnosis in the ambulatory setting. SETTING: 4 malpractice insurance companies. MEASUREMENTS: Diagnostic errors associated with adverse outcomes for patients, process breakdowns, and contributing factors. RESULTS: A total of 181 claims (59%) involved diagnostic errors that harmed patients. Fifty-nine percent (106 of 181) of these errors were associated with serious harm, and 30% (55 of 181) resulted in death. For 59% (106 of 181) of the errors, cancer was the diagnosis involved, chiefly breast (44 claims [24%]) and colorectal (13 claims [7%]) cancer. The most common breakdowns in the diagnostic process were failure to order an appropriate diagnostic test (100 of 181 [55%]), failure to create a proper follow-up plan (81 of 181 [45%]), failure to obtain an adequate history or perform an adequate physical examination (76 of 181 [42%]), and incorrect interpretation of diagnostic tests (67 of 181 [37%]). The leading factors that contributed to the errors were failures in judgment (143 of 181 [79%]), vigilance or memory (106 of 181 [59%]), knowledge (86 of 181 [48%]), patient-related factors (84 of 181 [46%]), and handoffs (36 of 181 [20%]). The median number of process breakdowns and contributing factors per error was 3 for both (interquartile range, 2 to 4). LIMITATIONS: Reviewers were not blinded to the litigation outcomes, and the reliability of the error determination was moderate. CONCLUSIONS: Diagnostic errors that harm patients are typically the result of multiple breakdowns and individual and system factors. Awareness of the most common types of breakdowns and factors could help efforts to identify and prioritize strategies to prevent diagnostic errors.

Overview

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Crossref · 10.7326/0003-4819-145-7-200610030-00006

Cites

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Citations

Cites

Research works printed but not linked: 3

  1. Studdert DM, 2000, Indiana Law Rev, 33, 1643
  2. Schoen C, 2004, Health Aff (Millwood), W4
  3. Guthrie C, 2001, Cornell Law Rev, 86, 777

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Metadata

Authors
Gandhi, T. K., Kachalia, A., Thomas, E. J., Puopolo, A. L., Yoon, C., Brennan, T. A., & Studdert, D. M.
Affiliations
Brigham and Women's Hospital (US)
ORCID
Venue
Annals of Internal Medicine
Publisher
American College of Physicians
Published
2006-10-03
Volume
145
Issue
7
Pages
488-496
ISSN
  • 0003-4819 (ISSN-L)
  • 1539-3704
DOI
10.7326/0003-4819-145-7-200610030-00006
OpenAlex
W2128347581
Cited by
662
References
36
Citations by year
2026: 12 · 2025: 25 · 2024: 21 · 2023: 26 · 2022: 33 · 2021: 34 · 2020: 39 · 2019: 41 · 2018: 39 · 2017: 33 · 2016: 32 · 2015: 55 · 2014: 42 · 2013: 42 · 2012: 40
FWCI
15.82
Type
journal article
Language
en
Open access
closed
Licence
www.acpjournals.org/journal/aim/text-and-data-mining (tdm)
Locations
  • Annals of Internal Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • UCLA - Biblioteca de Ciencias de la Salud (submittedVersion)
Funders
Agency for Healthcare Research and Quality (HS011886-03, KO2HS11285)
Topics
  • Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
  • Social Sciences › Law › Medical Malpractice and Liability Issues
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Patient Safety and Medication Errors
Keywords
missed diagnosis, delayed diagnosis, diagnostic errors, malpractice claims, outpatient care, patient safety, cancer diagnosis, breast cancer, colorectal cancer, follow-up care, handover, error prevention
MeSH terms
Adolescent, Adult, Aged, Ambulatory Care, Child, Child, Preschool, Diagnostic Errors, Female, Humans, Infant, Male, Malpractice, Middle Aged, Quality of Health Care, Retrospective Studies, United States

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