Reduce Medical Misdiagnosis To Improve Patient Safety

A patient experiencing very few symptoms that link to a wide range of medical conditions can be a challenge for healthcare professionals to treat. In a busy Emergency Department, medical misdiagnosis often occurs when patients with complex medical histories present with unrelated symptoms.

Review this claim study for tips on reducing the likelihood of medical malpractice misdiagnosis and improving patient care at your healthcare organization.

The Patient

A 45-year-old female was brought to the Emergency Department via ambulance where she was triaged with complaints of sudden onset acute chest pain, back pain, abdominal pain, and headaches with nausea and vomiting. The patient’s past medical history included hypertension and anemia.

The patient was seen by the Emergency Department physician and underwent a CT scan of her abdomen. The patient was then admitted to the care of an internal medicine specialist. The internal medicine specialist rounded on the patient and completed an exam.

Orders were made for a chest CT along with a neurological consult. Additional medications were ordered along with lab work and regular neurological checks.

That same evening, the patient coded. While resuscitation efforts were begun, those efforts were unsuccessful. The patient passed away.

The autopsy revealed the patient died from cardiac tamponade, ascending aortic dissection, and a clinical history of hypertension.

The Complaint

A PCF complaint was filed, and the Medical Review Panel reviewed all the evidence submitted, including a complete copy of the hospital and physicians’ medical records. The emergency department physician was found to have breached the standard of care for failure to appreciate the patient’s dire condition when she presented to the Emergency Department with near-classic symptoms of an aortic dissection.

The medical review panelists also opined that an echocardiogram or chest CT with contrast should have been ordered on a STAT basis. The EKG performed revealed ventricular hypertrophy that suggested an increased risk to the patient of sudden cardiac death, which they opined should have been appreciated by the physician.

The panel members were critical of what they felt was a failure of the physician to read or give enough weight to the nurses’ notes and triage report that had been taken upon her arrival.

The Medical Review Panel also found an issue with another Emergency Department physician defendant who responded to the patient’s code blue by failing to observe the patient’s pericardial effusion during the code. The panel found the physician should have performed a pericardiocentesis to remove the blood clots stopping the patient’s heart, potentially giving enough time for a thorough assessment of the dissection and surgical repair.

All defendants settled the litigation along with contributions from the Patient’s Compensation Fund.

Reduce the Likelihood of Medical Misdiagnosis

One-third of medical malpractice cases that result in death or permanent disability originate from an inaccurate or delayed diagnosis, making medical misdiagnosis the number one cause of serious harm among medical errors, according to the Society to Improve Diagnosis in Medicine.

Many complexities in healthcare, such as proper interpretation of test results, sub-specialty consultation availability, the accuracy of patient information obtained, and human factors, can contribute to a medical misdiagnosis by physicians.

Some recommendations to help reduce the likelihood of medical misdiagnosis, especially in the Emergency Department, include:

• Stay current on recommended standards of care from specialty-specific organizations.
• Incorporate current standards of care into protocols and electronic standard order sets.
• Know and comply with national guidelines for specific symptoms/diseases such as pneumonia, chest pain, etc.
• Implement and use decision-support resources.
• Identify and control human factors that influence care decisions, such as distractions or staffing issues.
• Encourage timely consultations as needed and input from the professional healthcare team, including the nurse’s interactions with the patient.
• Implement consultation for critical diagnostics that may not be available at the organization, such as psychiatry or neurology.
• Follow up on test results and proper handling of critical test results that are reported.
• Implement a physician hand-off process to ensure continuity of care among medical staff.
• Track and trend diagnostic issues per physician through On-going Physician Practice Evaluation (OPPE).
• Track and trend the most misdiagnosed diseases.
• Create community initiatives to encourage patients to become partners in their care through communication with the medical team and knowledge of their own disease processes.

“Physicians are human, and all humans make mistakes. They are impacted by human factors that can lead to error just like anyone else,” says Stacie Jenkins, Vice President of Patient Safety and Risk at LHA Trust Funds.

“It is important to reduce the human factors as much as possible in the clinical setting through the use of technology, hardwiring of processes, and environmental modification to help optimize performance and protect patient safety.”

Access Our Emergency Department Toolkit

Since medical misdiagnosis is the leading cause of medical malpractice claims, it’s important to incorporate other tools and processes to complement the physician’s evaluation of the patient. Failure to diagnose or a delayed diagnosis could lead to greater illness or injury, and in some cases, patient death.

A proper diagnosis often starts with patient care in the Emergency Department. Explore the resources in our Emergency Department Toolkit with your medical care team to help refine your organization’s processes and improve patient safety.

About The Authors

Jamie Lamb
Director of Claims Operations, LHA Trust Funds

Jamie Lamb began her career in claims in 1997. Her experience includes handling multi-line claims in the areas of general liability, medical malpractice, automobile liability, commercial and personal property, excess and umbrella policies, and professional liability. Her experience comes as a former Manager and Litigation Specialist for the American National family of companies. She has been highly involved in the education and training of both internal and external customers her entire career. Ms. Lamb attended both Evangel University in Springfield, Missouri, and Loyola University in New Orleans.

Stacie Jenkins, RN, MSN, CPSO
Vice President of Patient Safety and Risk, LHA Trust Funds

Stacie Jenkins is a registered nurse with a master’s degree in nursing informatics. She has more than 20 years of experience in healthcare, working in patient care and quality/performance improvement positions. As the Vice President of Patient Safety & Risk at LHA Trust Funds, she works closely with hospital administrators, risk managers, and nursing staff to improve patient safety and establish best practices. She conducts on-site assessments and gives presentations designed to help clients address their patient safety risk management challenges.