Diagnostic Error

Professional Education
Delayed Diagnosis of Sepsis (Claims Corner CME)
In reviewing closed malpractice claims, The Doctors Company has identified delayed diagnosis and treatment of sepsis as a serious problem that can result in significant morbidity and mortality. This article highlights the importance of timely recognition of symptoms that point to a diagnosis of sepsis, and the need for quick initiation of treatment. Factors contributing to the delayed diagnosis and treatment of sepsis are discussed, including clinical judgment errors such as failure to note the importance of significant clinical symptoms, failure to seriously consider sepsis as high on the differential diagnosis, failure to use a sepsis recognition tool as an adjunct to the exam, failure to order appropriate tests to rule out sepsis before assuming another diagnosis, and failure to admit the patient to the hospital for treatment.
0.8 credit

Professional Education
Test Tracking and Referrals: Strategies for Advanced Practice Clinicians
Tracking of tests and consults is critically important in preventing diagnostic errors and preventing patient harm. The risk factors triggering an alleged malpractice claim were primarily related to the breakdown in clinical systems for test result management. Failures of systems often prevent providers from making timely and accurate diagnoses. Testing failures included test performance issues, misinterpretation of studies, receipt, and transmittal problems. Follow-up failures included lack of physician follow-up with the patient, referral management, inadequate provider to provider communication and patient noncompliance.
0.8 credit

Professional Education
Delayed Diagnosis of Malignancy: Case Review for Advanced Practice Clinicians
In reviewing closed malpractice claims, The Doctors Company identified delayed diagnosis of a malignancy as a reoccurring problem. The following highlights the importance of recognizing a spinal abnormality and recommending further follow up of a lesion seen on imaging. Contributing factors include misinterpretation of radiologic studies, narrow diagnostic focus, lack of communication, and failure to establish a differential diagnosis.
0.5 credit

Professional Education
Delayed Diagnosis of Stroke: Case Review for Advanced Practice Clinicians
In reviewing closed malpractice claims, The Doctors Company identified diagnostic failure as a reoccurring problem and one of the top three leading allegations that result in malpractice claims. This failure often leads to a delay in treatment and causes significant harm to patients. The following highlights the importance of recognizing the signs and symptoms of a stroke. Factors contributing to delay diagnosis and treatment included failure to recognize the window (“last known well time”) for tissue plasminogen activator-clot buster (tPA) failure to order a stat MRI and neurology consult, failed communication among providers regarding changes of recurring symptoms of ischemic stroke, failure to appreciate new signs and symptoms of a stroke, and poor or inconsistent documentation. The National Academy of Medicine (NAM) has identified the top three causes of serious harm from diagnostic failure. Number one is ischemic stroke.
0.5 credit

Professional Education
Preventing Diagnostic Error in Primary Care: Strategies for Advanced Practice Clinicians
Diagnostic errors occur often in primary care settings and can impact over 12 million outpatients annually. This is a top patient safety concern and a global burden among advanced practice clinicians (APCs). Significant patient harm can occur due to treatment delay, testing, or misdiagnosis. This course is an opportunity to promote awareness and visibility by identifying where these errors occur most often in the diagnostic process of care framework. Examples of some best practices for the diagnostic process involves a timely and accurate diagnosis, patient engagement, effective system processes, active follow up, and communication. The information in this course will focus heavily on prevention strategies related to the primary care setting.
0.8 credit

Jun 17, 2022
As Telemedicine Best Practices Emerge, Assess Your Practice
David L. Feldman, MD, MBA, FACS, Chief Medical Officer, The Doctors Company and TDC Group; Senior Vice President, Healthcare Risk Advisors
Healthcare leaders have discovered that remote care reveals some unexpected advantages.
From The Doctor’s Advocate

Professional Education
Clinical Presentations for Advanced Practice Clinicians: Failure to Diagnose Myocardial Infarctions
In reviewing closed malpractice claims, TDC Group identified missed or delayed diagnosis of myocardial infarction (MI) in the ambulatory internal medicine setting as a reoccurring problem. This course highlights the importance of recognizing the varying clinical presentations of MI and contributing factors associated with failure to diagnose and treat. Assumptions, lack of a thorough history and physical, communication failures, and failure to recognizing atypical signs and symptoms are highlighted in this case study.
0.5 credit

Professional Education
Delayed Diagnosis of Prostate Cancer
Clinical judgment can prevent physicians from making timely diagnoses. Failures may result when patient assessments are incomplete, there is a narrow diagnostic focus, or a routine screening test is not ordered. In reviewing closed malpractice claims, The Doctors Company identified missed or delayed diagnosis of prostate cancer in the ambulatory Family Practice setting as a reoccurring problem.
0.5 credit

Apr 04, 2022
Strategies for Effective Patient-Assisted Telehealth Assessments
Sue Boisvert, BSN, MHSA, Senior Patient Safety Risk Manager, The Doctors Company
Physicians who practice telemedicine must consider the components needed to complete an effective remote assessment and plan ahead based on their specialty area and the patient’s presenting complaint.

Apr 01, 2022
Delay in Diagnosing Breast Cancer: A Case Summary and Tips to Reduce Risk
Lisa M. McCorkle, MSN, MBA, Senior Patient Safety Risk Manager, Department of Patient Safety and Risk Management, The Doctors Company
A delay in diagnosing breast cancer may result when a patient doesn’t follow through with diagnostic recommendations.

Nov 29, 2021
The Evolving Landscape of Diagnostic Errors—Challenges and Opportunities
David E. Newman-Toker, MD, PhD, Professor of Neurology, Ophthalmology, and Otolaryngology, and Director, Armstrong Institute Center for Diagnostic Excellence, Johns Hopkins University School of Medicine
Internationally recognized healthcare leader David E. Newman-Toker, MD, PhD, presents a compelling case example and shares key insights into transforming diagnostic accuracy.
From The Doctor’s Advocate

Nov 19, 2021
Failure to Diagnose and Refer Results in Court and Dental Board Action
This case explores the issues surrounding a misdiagnosis claim and outlines steps to help dental professionals avoid these types of allegations.

Nov 15, 2021
To Measure and Reduce Diagnostic Error, Start With the Data You Have
David L. Feldman, MD, MBA, FACS, Chief Medical Officer, The Doctors Company and TDC Group; Senior Vice President, Healthcare Risk Advisors
Chief Medical Officer David L. Feldman, MD, MBA, FACS, recaps important recommendations by diagnostic safety expert Hardeep Singh, MD, MPH, for measuring and reducing diagnostic error.
From The Doctor’s Advocate

Professional Education
Clinical Presentations Cause Delays: Failure to Diagnose Myocardial Infarction
In reviewing closed malpractice claims, The Doctors Company identified missed or delayed diagnosis of myocardial infarction (MI) in the ambulatory internal medicine setting as a reoccurring problem. This course highlights the importance of recognizing the varying clinical presentations of MI and contributing factors associated with failure to diagnose and treat. Assumptions, lack of a thorough history and physical, communication failures, and failure to recognizing atypical signs and symptoms are highlighted in this case study.
0.5 credit

Professional Education
Delayed Diagnosis of Stroke
In reviewing closed malpractice claims, The Doctors Company identified diagnostic failure as a reoccurring problem and one of the top three leading allegations that result in malpractice claims. This failure often leads to a delay in treatment and causes significant harm to patients. The following highlights the importance of recognizing the signs and symptoms of a stroke.
0.5 credit

Video Oct 28, 2021
What Clinical Support Tools Can Help Emergency Department Physicians Reduce Diagnostic Errors?
Emergency department systems and processes can increase or reduce the risk of diagnostic error. But instead of simply asking clinicians to work harder or smarter, what’s needed is the creation of a system of care that optimizes their ability to think and carry out an efficient work-up of a patient. Learn more from Jacqueline Ross, PhD, RN, CPAN, our coding director.

Oct 25, 2021
Flu or COVID-19? Convergence of Two Viruses Creates Risk of Diagnostic Errors
Susan Shepard, MSN, CPHRM, Senior Director, Patient Safety and Risk Management Education, The Doctors Company
Understanding the differences between the flu and COVID-19 will help to prevent misdiagnosis or delayed diagnosis of either disease.

Oct 20, 2021
Diagnostic Error in General Surgery: Cognitive Bias and Systems Issues in Medical Malpractice Claims (Abstract)
Jacqueline Ross, RN, PhD, Coding Director, Department of Patient Safety and Risk Management
Although claims against general surgeons primarily allege technical surgical-type errors, diagnostic error is the second most frequent allegation against or case type for general surgeons. Analysis of malpractice claims can elucidate the causes of and solutions to diagnostic errors. This study considers differences between diagnostic errors, both cognitive and systemic, committed by general surgeons in the inpatient vs. the outpatient setting.

Professional Education
Alzheimer's 2: Evaluation and Diagnosis of Alzheimer’s Disease and Related Dementias
This activity includes eight video lectures and is the second in a series of four courses that seek to educate clinicians on standardized screening, evaluation, and disease management of Alzheimer’s disease and related dementias. This second course introduces the Alzheimer’s project evaluation algorithm and evaluation instruments and focuses on differential diagnoses. Finally, the course discusses how to prepare and engage in a sensitive dementia diagnosis disclosure with patients and caregivers.
1.5 credits

Sep 29, 2021
Getting Sued for Breast Cancer Malpractice
Richard E. Anderson, MD, FACP, Chairman and Chief Executive Officer, The Doctors Company and TDC Group
Our closed claims data reveal that suits involving breast cancer are the most common type of cancer-related claim. This article lists the issues that most often lead to claims.

Professional Education
Pathologists and Surgeons Can Collaborate to Reduce Diagnostic Error
The Doctors Company has updated the claims filed against pathologists between the years 2015 and 2020. The information provides quantitative and qualitative data that a pathologist and surgeon would find meaningful in reducing diagnostic error. This program provides a breakdown of where patient injuries occur involving pathologists and surgeons and how collaboration between the two disciplines can improve patient outcomes.
1.0 credit

Aug 04, 2021
Cognitive Assessments in Primary Care: Preparation and Tools May Mitigate Diagnosis Risks
Carol Murray, RHIA, CPHRM, Senior Patient Safety Risk Manager, The Doctors Company, Part of TDC Group
Recent reimbursement changes by the Centers for Medicare and Medicaid Services (CMS) allow primary care providers to meet their patients’ mental health needs and help build their practices by performing cognitive assessments.

Jun 18, 2021
Study of Emergency Department Diagnosis Case Type Malpractice Claims: Abstract
Jacqueline Ross, RN, PhD, Coding Director, Department of Patient Safety and Risk Management
A study of diagnosis-type closed medical malpractice claims from care that occurred in the ED from 2014 through the second quarter of 2019 using closed coded claims from The Doctors Company.

Professional Education
Breast Cancer Claims – A Review in Gynecology
Breast cancer medical negligence claims are reviewed over a ten-year period to identify the major case types in which the gynecologist is the responsible party. The factors that contributed to those claims as identified by plaintiff and defense physician experts are discussed through case examples with learner questions. Risk mitigation strategies are identified to guide gynecologists in further providing the safest patient care and thereby improving their risk profile.
1.0 credit

Professional Education
Diagnostic Radiology: Analysis of Closed Malpractice Claims
Studying diagnostic radiology malpractice claims provides an understanding of drivers of lawsuits and patient injuries that result. By analyzing these claims and identifying the contributing factors involved in these, risk mitigation strategies can be developed and implemented reducing adverse patient outcomes and increasing patient safety.
0.8 credit

Jan 28, 2021
Missed Diagnosis of Spinal Epidural Abscess
David B. Troxel, MD, Medical Consultant to The Doctors Company
Spinal epidural abscess requires prompt diagnosis and treatment to prevent serious neurological complications.

Professional Education
Diagnostic Radiology: A Failure to Diagnose
In reviewing closed malpractice claims, The Doctors Company identified delayed diagnosis of a malignancy as a reoccurring problem. The following highlights the importance of recognizing a spinal abnormality and recommending further follow up of a lesion seen on imaging. Contributing factors include misinterpretation of radiologic studies, narrow diagnostic focus, lack of communication and failure to establish a differential diagnosis.
0.5 credit

Professional Education
Prevention of Diagnostic Error in Primary Care
Diagnostic errors occur often in primary care settings and can impact over 12 million outpatients annually. This is a top patient safety concern and a global burden. Significant patient harm can occur due to treatment delay, testing, or misdiagnosis. This course is an opportunity to promote awareness and visibility by identifying where these errors occur most often in the diagnostic process of care framework.
1.0 credit

Professional Education
Spotlight on Diagnosing PE/DVT
The overall incidence of venous thromboembolism (VTE) —including both deep vein thrombosis (DVT) and pulmonary embolism (PE) —is one case per 1000 patient years. Accurate and timely diagnosis of VTE can be improved with the use of diagnostic guidelines such as Wells criteria and scoring for both DVT and PE.
0.5 credit

Oct 13, 2020
Otolaryngology: Reduce Risk When Performing Diagnostic Imaging Services
Sue Boisvert, BSN, MHSA, Patient Safety Risk Manager II
Adding point-of-care imaging to an otolaryngology practice is convenient for patients and a source of revenue for the practice. It also comes with responsibility and potential risk.

Professional Education
Cauda Equina Syndrome: A Failure to Diagnose
Failures of systems often prevent physicians from making timely diagnoses. Failures may result when patient assessments are incomplete, having a narrow diagnostic focus, or diagnostic test issues. Other factors that hinder timely diagnoses include failure to appreciate signs and symptoms, lack of consults, and failure to respond to repeated patient concerns/symptoms.
0.5 credit

Professional Education
Diagnostic Cardiology Closed Claims Study: An Expert Analysis of Medical Malpractice Allegations
The specialty of cardiology is complex and has underlying vulnerabilities that can put patients at risk of injury and can increase liability for cardiologists and other clinicians who treat heart patients. Understanding common areas of liability and risk exposure are a valuable way to make effective practice improvements.
0.5 credit

Video Jun 25, 2020
How Can AI Reduce Misdiagnosis?
Eric Topol, MD, founder and director of The Scripps Research Translational Institute and author of Deep Medicine: How Artificial Intelligence Can Make Healthcare Human Again, explores how artificial intelligence (AI) might be used to reduce misdiagnoses. This is the second in a series on AI in medicine that Dr. Topol has done in conjunction with The Doctors Company.

Professional Education
Neurosurgery: Communications and System Failure Leading to Diagnostic Error
Failures of systems often prevent physicians from making timely diagnoses. Failures may result when needed equipment isn’t available or when access to a patient is difficult. System failures may result when there is a lack of coordination of appropriate care among providers, or when poor communication among providers leads to missed and delayed diagnoses.
0.5 credit

Feb 11, 2020
Laboratory and Diagnostic Test Tracking in Ambulatory Practice
Dana Faber, MS PSL, RN, Senior Patient Safety Risk Manager
Inadequate clinical laboratory and diagnostic test tracking is a top factor leading to patient injury.

Dec 02, 2019
Diagnostic and Interventional Radiology Closed Claims Study
Darrell Ranum, JD, CPHRM, Vice President, Department of Patient Safety and Risk Management
The Doctors Company analyzed 596 medical malpractice claims against diagnostic and interventional radiologists that closed from 2013 through 2018, identifying the top allegations and factors contributing to patient injury.

Oct 31, 2019
The Algorithm Will See You Now: How AI’s Healthcare Potential Outweighs Its Risk
A third of U.S. physicians are already using artificial intelligence (AI) in their practices, and many believe there is ample reason to think this advanced technology can help address diagnostic errors—the largest cause of malpractice claims. However, there are still unresolved questions about the risks.

Jun 13, 2019
The Waning of the Physical Examination and Its Impact on Outcomes
Howard Marcus, MD, FACP
The physical exam should remain a central tool for evaluating and managing patients.
From The Doctor’s Advocate

Dec 14, 2016
The Doctor’s Dilemma
Howard Marcus, MD, FACP
From The Doctor’s Advocate

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