Characteristics and contributing factors of diagnostic error in surgery: analysis of closed medico-legal cases and complaints in Canada

Diagnostic errors lead to patient harm; however, most research has been conducted in nonsurgical disciplines. We sought to characterize diagnostic error in the pre-, intra-, and postoperative surgical phases, describe their contributing factors, and quantify their impact related to patient harm. We...

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Veröffentlicht in:Canadian Journal of Surgery 2024-02, Vol.67 (1), p.E58-E65
Hauptverfasser: Kwan, Janice L, Calder, Lisa A, Bowman, Cara L, MacIntyre, Anna, Mimeault, Richard, Honey, Liisa, Dunn, Cynthia, Garber, Gary, Singh, Hardeep
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Sprache:eng
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Zusammenfassung:Diagnostic errors lead to patient harm; however, most research has been conducted in nonsurgical disciplines. We sought to characterize diagnostic error in the pre-, intra-, and postoperative surgical phases, describe their contributing factors, and quantify their impact related to patient harm. We performed a retrospective analysis of closed medico-legal cases and complaints using a database representing more than 95% of all Canadian physicians. We included cases if they involved a legal action or complaint that closed between 2014 and 2018 and involved a diagnostic error assigned by peer expert review to a surgeon. We identified 387 surgical cases that involved a diagnostic error. The surgical specialties most often associated with diagnostic error were general surgery ( = 151, 39.0%), gynecology ( = 71, 18.3%), and orthopedic surgery ( = 48, 12.4%), but most surgical specialties were represented. Errors occurred more often in the postoperative phase ( = 171, 44.2%) than in the pre- ( = 127, 32.8%) or intra-operative ( = 120, 31.0%) phases of surgical care. More than 80% of the contributing factors for diagnostic errors were related to providers, with clinical decision-making being the principal contributing factor. Half of the contributing factors were related to the health care team ( = 194, 50.1%), the most common of which was communication breakdown. More than half of patients involved in a surgical diagnostic error experienced at least moderate harm, with 1 in 7 cases resulting in death. In our cohort, diagnostic errors occurred in most surgical disciplines and across all surgical phases of care; contributing factors were commonly attributed to provider clinical decision-making and communication breakdown. Surgical patient safety efforts should include diagnostic errors with a focus on understanding and reducing errors in surgical clinical decision-making and improving communication.
ISSN:0008-428X
1488-2310
DOI:10.1503/cjs.003523