Case Analysis Examines Vulnerabilities in Diagnostic Process

January 13, 2015 ‐ PSQH

Understanding a problem is prerequisite to fixing it. For a newly released report, CRICO Strategies analyzed more than 4,700 malpractice cases related to diagnosis to determine patterns of error, where problems are most likely to occur, and how to most effectively improve diagnosis.

The cases analyzed come from CRICO Strategies’s Comparative Benchmarking System (CBS), which contains more than 300,000 open and closed medical malpractice cases from medical organizations affiliated with Harvard University and CRICO Strategies’ partners from around the country. The report, Malpractice Risks in the Diagnostic Process is CRICO Strategies’ 2014 Annual Benchmarking Report.

Among 23,527 cases filed from 2008 through 2012, 20% or 4,703 cases, related to diagnosis. Fifty-seven percent of those cases originated in ambulatory care, and the top three missed diagnoses were cancer, heart disease, and orthopedic injuries. Twenty-six percent of the diagnosis-related cases originated in inpatient care and 16% in emergency care.

Nurses code the cases in the CBS using a taxonomy that is then mapped to CRICO’s 12-step “diagnostic process of care framework.” The resulting data analysis promotes understanding clinicians’ thought processes related to diagnosis in detail and designing improvement strategies accordingly. In ambulatory diagnosis cases, analysts found that 75% of contributing factors had to do with clinical judgment, with 25% related to patient behavior (adherence) and 24% to communication breakdowns, with multiple factors in most cases. The report offers further analysis of lapses in clinical judgment in one of many graphics that enhance the text of this detailed, thoughtful report.

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