Defining Diagnostic Error: A Scoping Review to Assess the Impact of the National Academies’ Report Improving Diagnosis in Health Care

Abstract

BackgroundStandards for accurate and timely diagnosis are ill-defined. In 2015, the National Academies of Science, Engineering, and Medicine (NASEM) committee published a landmark report, Improving Diagnosis in Health Care, and proposed a new definition of diagnostic error, “the failure to (a) establish an accurate and timely explanation of the patient’s health problem(s) or (b) communicate that explanation to the patient.”ObjectiveThis study aimed to explore how researchers operationalize the NASEM’s definition of diagnostic error with relevance to accuracy, timeliness, and/or communication in peer-reviewed published literature.MethodsUsing the Arskey and O’Malley’s framework framework, we identified published literature from October 2015 to February 2021 using Medline and Google Scholar. We also conducted subject matter expert interviews with researchers.ResultsOf 34 studies identified, 16 were analyzed and abstracted to determine how diagnostic error was operationalized and measured. Studies were grouped by theme: epidemiology, patient focus, measurement/surveillance, and clinician focus. Nine studies indicated using the NASEM definition. Of those, 5 studies also operationalized with existing definitions proposed before the NASEM report. Four studies operationalized the components of the NASEM definition and did not cite existing definitions. Three studies operationalized error using existing definitions only. Subject matter experts indicated that the NASEM definition functions as foundation for researchers to conceptualize diagnostic error.ConclusionsThe NASEM report produced a common understanding of diagnostic error that includes accuracy, timeliness, and communication. In recent peer-reviewed literature, most researchers continue to use pre-NASEM report definitions to operationalize accuracy and timeliness. The report catalyzed the use of patient-centered concepts in the definition, resulting in emerging studies focused on examining errors related to communicating diagnosis to patients.

Japanese Internists' Most Memorable Diagnostic Error Cases: A Self-reflection Survey

“…Thus, we consider it highly likely that fundamental differences in clinical settings underlie differences in the etiologies of the errors that were observed in Japan relative to the US. Research on diagnostic errors in many countries outside the United States is scarce ( 47 ), and contradictory findings regarding the causes of diagnostic errors due to differences among countries and health care systems cannot be ignored. Therefore, situational factors and relevant system errors must be considered to be causes of diagnostic errors, and their contributing factors should be explored to improve the working environment in Japanese medical settings.…”

“…This allowed for a unique lens and understanding of the causes of diagnostic errors ( 6 ). As a result, we were able to substantially/effectively reduce the arbitrary manipulation of causes of error that often occurs when using third-party data ( 26 , 27 , 47 - 49 ). Second, this is the first large-scale nationwide diagnostic error study conducted in Japan.…”