Factors Associated With Diagnostic Error: An Analysis of Closed Medical Malpractice Claims

Abstract

IntroductionMissed and delayed diagnoses have received substantial attention as a quality and patient safety priority. To the extent that electronic health records, team-based care, and other mitigation strategies have been successful in improving diagnosis since the last large-scale study, we would expect that the contributing factors to diagnostic claims may have changed.MethodsThis study sought to examine paid medical malpractice claims as a proxy to identify contributing factors that reflect a clear diagnostic error. Diagnostic error cases with indemnity payments (2009–2020) were identified using the Candello (formerly known as CRICO) proprietary taxonomy. Factors associated with indemnity payments were analyzed using a multivariable logistic regression model.ResultsOf 5367 included claims, 2161 (40%) had indemnity payments. A majority of claims had multiple contributing factors on the diagnostic pathway. In multivariable analysis, factors independently associated with an indemnity payment included the insurer (odds ratio and 95% confidence interval, 2.8 [2.4–3.3]), high injury severity (1.9 [1.3–2.8]) or death (1.5 [0.99–2.1]), and case setting (inpatient (0.77 [0.65–0.91]) or emergency department (0.67 [0.49–0.92])). Importantly, cases with contributing factors outside of Candello’s diagnostic pathway were more likely to lead to indemnity payment.ConclusionsThe digital transformation and acceleration of team-based care in medicine have not mitigated the malpractice risks of complex cases with severe injuries and multiple missteps.

An analysis of medical malpractice claims against medical oncologists from a national database: Implications for safer practice

“…The selection of 100 random cases for thematic analysis includes cases without payment. While the data are mixed as to whether claims closing with payment do 22 or do not 30 correlate with errors, this too may limit the generalizability of our findings.…”