Hospitals across the United States are failing to properly diagnose patients, resulting in widespread preventable patient harm and deaths, according to several new studies published this month. Researchers found that diagnostic errors are common, especially among racial minorities and women, and are a major contributor to patient deaths and transfers to the intensive care unit (ICU).
New Research Shows 1 in 15 Hospital Deaths Caused by Diagnostic Error
A groundbreaking study published in the journal Diagnosis analyzed over 47,000 patient cases across five hospitals and found that diagnostic errors were a contributing factor in 1 out of every 15 patient deaths. The study also found that 35% of patients who were transferred to the ICU and 40% of patients who died had experienced a diagnostic error.
Lead researcher Dr. David Newman-Toker from Johns Hopkins University School of Medicine said, “Diagnostic errors have been called medicine’s ‘blind spot,’ and our findings reinforce that such errors contribute to substantial preventable harm and premature death among hospitalized patients.”
The types of missed or wrong diagnoses included infections, blood clots, drug reactions, sepsis, fractures, strokes, and heart attacks. Researchers noted that these diagnostic errors were preventable and that earlier diagnosis and treatment could have prevented further harm or death.
“This study provides some of the most definitive evidence to date on the substantial harm caused by diagnostic errors in hospitals,” said Dr. Newman-Toker. “It confirms diagnostic errors as a leading cause of preventable patient harm and underscores the critical need to improve diagnosis in hospitals through clinical, educational, and policy interventions.”
Racial Minorities and Women Bear the Brunt of Diagnostic Disparities
In addition to the overall high rate of diagnostic errors found by Dr. Newman-Toker’s study, other recent research has highlighted significant racial, ethnic, and gender disparities when it comes to misdiagnoses in hospitals.
A study published in JAMA Network Open in December 2023 analyzed nearly 250,000 hospital discharges and found that Black patients had a 19% higher chance of experiencing a diagnostic error compared to White patients. Hispanic patients had a 11% higher chance compared to White patients.
| Racial Disparities in Rates of Diagnostic Errors |
|-|
| Black patients | 19% higher |
| Hispanic patients | 11% higher|
“Our findings point to an urgent need to develop targeted interventions to reduce racial and ethnic disparities in diagnostic safety,” said lead researcher Dr. Karen Joynt Maddox from Washington University School of Medicine.
Researchers noted that potential factors contributing to higher misdiagnosis rates among minorities include communication barriers, racial bias among clinicians, and minorities being more likely to seek care at low-quality, resource-constrained hospitals.
Another study published earlier this month in JAMA found that women hospital patients are significantly more likely to experience diagnostic errors compared to men. Analyzing over 5 million hospital cases, researchers found a 7% higher likelihood of missed or delayed diagnosis among women compared to similar matched cases with men. This equals over 30,000 more diagnostic errors per year for women.
| Gender Disparities in Rates of Diagnostic Errors |
|-|
| Women | 7% higher |
“The numbers here are troubling, especially considering how often women seek health care,” said lead study author Dr.Ashley Weimer from the Cedars-Sinai Medical Center. “This demands further exploration to understand why this type of harm is happening more often in women, so it can be stopped.”
Preventing Diagnostic Errors Requires System-Level Changes
In response to these concerning findings on the prevalence of diagnostic errors and related disparities in US hospitals, many patient safety experts are calling for major improvements in medical training, diagnostic tools, teamwork, and healthcare technology systems.
“Diagnostic errors are complex and solving this crisis requires a multifaceted approach focused on the entire sociotechnical system,” said Dr. Hardeep Singh, chief of health policy and quality at the Houston VA Medical Center.
Some key recommendations emerging include:
- Enhanced medical education and training focused on clinical reasoning, diagnostic challenges, and bias reduction
- Reducing clinician burnout and workloads
- Improved teamwork and communication among clinicians
- Wider adoption of diagnostic decision support tools and AI systems
- Policy changes to incentivize diagnostic safety improvements
“This is a solvable problem,” said Dr. Newman-Toker regarding diagnostic errors. “We know the types of vulnerabilities in our diagnostic processes, and we have solutions that can directly target these vulnerabilities. What has been lacking is the motivation and urgency to implement these solutions. These sobering data should be that motivation.”
Researchers emphasize that hospitals and policy makers need to act quickly to address this patient safety crisis, as diagnostic errors continue to result in a large number of preventable deaths and disability across the country. They warn that inaction will perpetuate these inequities and safety gaps for years to come.
Outlook: Pressure Mounting for Reform
With alarming new data continuing to emerge on the prevalence of diagnostic errors and related disparities, pressure is mounting for substantial reforms aimed at improving diagnosis and reducing preventable patient harm.
Medical societies, policy experts, patient advocates and government agencies are increasingly speaking out on the need for transformative changes in how diagnoses are performed in our hospitals. Key lawmakers are also getting involved, with bipartisan legislation expected to be introduced in 2024 aimed at making diagnostic safety a national priority.
“The human toll of diagnostic errors is enormous — over 100,000 patients dying each year – and the data shows it disproportionately impacts minorities and vulnerable groups,” said Rep. Michael Burgess (R-Texas), co-chair of the Congressional Diagnostic Error Caucus. “We have a responsibility to come together and fix our diagnostic processes to prevent these tragic outcomes.”
While reform won’t happen overnight, the growing spotlight on this patient safety crisis is seen as a pivotal first step toward largescale improvements in diagnostic care and safety over the next decade. Researchers are optimistic that with sustained leadership, attention, and resources, dramatic progress can be achieved.
“We are confident that ten years from now, we’ll look back and be stunned at just how unsafe our diagnostic systems used to be,” said Dr. Newman-Toker. “And we’ll celebrate the reforms that addressed these vulnerabilities and safer diagnostic care for all.”
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