Study looks at outcomes impact of errors

Malpractice data provides 25 year analysis

Malpractice information from the National Practitioner Data Bank over 25 years has showed that most mistakes come from diagnostic errors, not surgical mistakes or medication errors, according to a study published in the British Medical Journal’s Quality and Safety journal1. Most of those diagnostic issues stem from outpatient, not inpatient visits, but the inpatient errors were more likely to result in death.

Johns Hopkins researchers looked at more than 350,000 paid malpractice claims from 1986-2010. About a third of them came from diagnostic errors, accounting for more than a third of the payouts. Death was a more common outcome for this kind of error than for others — just under 41% versus about 30% for other errors. A third of the claims for diagnosis problems occurred in the inpatient setting, and those in the hospital were more likely to result in death than those from outpatient settings. The inflation-adjusted, 25-year sum of diagnosis-related payments was $38.8 billion, with a mean payout of $387,000 and a median of $213,000. Non-lethal serious injury was as common as death from misdiagnoses.

Errors in diagnosis are defined in the study as delayed diagnosis, missed diagnosis, or wrong diagnosis. The authors note that this kind of error is underreported and under-tracked because they are hard to measure and hard to keep track of.

While the focus of this study was errors that ended up with a malpractice claim, the authors believe that total number of diagnostic errors is between 80,000-160,000 each year in the United States.

The potential cost from diagnostic errors is large, and the authors, who include safety guru Peter Pronovost, say that organizations and stakeholders should start looking at ways to improve diagnostic safety.


1. Tehrani AS, Lee HW, Mathews SC et al. 25-Year summary of US malpractice claims for diagnostic errors 1986–2010: an analysis from the National Practitioner Data Bank. BMJ Qual Saf. 2013 Apr 22. [Epub ahead of print]