Presenter: Martin L. Kabongo, M.D., Ph.D.
Institution: San Diego Unified Research in Family Medicine (Surf*Net), La Jolla, California
Introduction: Outpatient primary care setting needs a system of evaluating and reporting diagnostic errors separate from those for hospital based specialists/attending. DEER (Diagnosis Error Evaluation Research Survey) is a collaborative multi-sites/centers study with Surf*Net providing primary care aspects of diagnostic errors.
Methods: A pilot study using DEER survey instrument was conducted among the primary care faculty to provide qualitative preliminary results on which to base our more comprehensive future study among primary care physicians members of Surf*Net.The ultimate goal of DEER, a descriptive survey, is to help characterize the epidemiology and prevalence of diagnosis errors as observed by primary care and specialists in a variety of clinical areas in multiple institutions. The preliminary pilot survey questionnaire asked physicians to list three clinically significant diagnosis errors they had seen in their practice. The preliminary pilot study is non-experimental descriptive survey design with questionnaire administered to collect data on physicians’ experience with diagnosis errors. The survey questionnaire used four point Likert scale. There was no comparison between a control and experimental groups. The survey questionnaire was distributed at the divisional faculty to those who were in attendance and who consented to participate after reading the attached self-explanatory description of the survey instrument. All responses were anonymous.
Results: Pilot study results reported using this survey instrument was conducted among the primary care faculty. In that study, sixteen faculty members participated and completed the survey. They were also asked to critique/evaluate and suggest the improvement of the survey instrument. Their comments were generally positive in favor to leave current protocol as such: "This is a reasonable tool." Following are some comments and preliminary results: Of 16 faculty who participated 16 different errors were found. They were all clustered in 3 areas: 1) wrong diagnosis, 2) delay in diagnosis, 3) misdiagnosis/failure to diagnose. The majority of participants observed errors committed by others. Most errors reported had minor to moderate impact on clinical outcome. Interestingly most junior faculty (less than five to 7 years in practice) seemed to find more errors made by others. Senior faculty were more introspective and were more likely to report the errors they committed themselves. Finally most participants were able to describe what went wrong but unable to describe why it happened.
Discussion: We hope that the proposed study would expand, provide additional insights, and obtain information from a large sample of primary care physicians regarding prevalence and distribution of diagnosis errors. It is anticipated that DEER final results will form the basis for contemplated future studies to reduce diagnosis errors in medicine. The proposed feasibility study of reducing or eliminating focuses on three major categories of diagnostic errors: 1) "no-fault errors" which occur when the disease is silent, 2) "system errors" which play a role when a diagnosis is delayed or missed because of the latent imperfection in the health care system, and 3) "cognitive errors" which reflect misdiagnosis from faulty data collection or interpretation, flawed reasoning, or incomplete knowledge.According current taxonomy, errors in primary care can be broadly classified either as process errors or errors of knowledge/skills. The proposed DEER study falls under errors of skills and knowledge. These preliminary results provide a starting point for future epidemiological and interventional research in which we will be eventually interested to study.
DEER (Diagnostic Error Evaluation Research) Study
