Prevalence and Classification of Misdiagnosis Among Hospitalised Patients in Five General Hospitals of Central Uganda

Katongole, Simon Peter; Akweongo, Patricia; Anguyo, Robert; Kasozi, Daniel Evans; Adomah-Afari, Augustine

doi:10.2147/ca.s370393

Cited by 4 publications

References 26 publications

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Factors associated with misdiagnosis of hospitalised patients in general hospitals of Central Uganda

Katongole¹,

Akweongo

DDMO

et al. 2022

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Misdiagnosis of inpatients is a major public health issue whose scope and causes are unknown in Sub-Saharan African countries. The purpose of this cross-sectional study, which was conducted in five hospitals in central Uganda, was to identify the factors associated with inpatient misdiagnosis in general hospitals in Central Uganda. Records of 2,431 patients admitted between July 1st, 2019 and June 30th, 2020 were specifically reviewed to obtain data on variables thought to be associated with misdiagnosis. The admission diagnosis assigned at the emergency or outpatient department was compared to the discharge diagnosis assigned immediately after the patient’s admission, with any difference considered a misdiagnosis. The disease, patient, health system, and environmental factors associated with misdiagnosis were identified using multivariable logistic regression analysis.Misdiagnosis was found in the records of 223/2431 (9.2%) of the admitted patients. A patient admitted to Nakaseke hospital [aOR=1.95, 95% CI=1.17-3.25, p=0.01], being admitted at night [aOR=3, 95% CI=1.81-5.02, p0.01], male patient [aOR=1.89, 95% CI=1.35-2.64, p0.01], patient’s age groups 10-19 [AOR=2.3, 95% CI=2.3-9.25, p0.01]; 20-29 [AOR=8.15, 95% CI=4.18-15.89], p<0.01; 30-39; and 40-49;; AOR=8.12, 95% CI=3.99-16.54, p<0.01; AOR=7.88, 95% CI=3.71-16.73, p<0.01; and AOR=12.14, 95% CI=6.41-23.01, p<0.0]. Misdiagnosis was also associated with multimorbidity (aOR=4.71, 95% CI=1.91-11.65, p0.01) and patients treated for uncommon diseases (aOR=2.57, 95% CI=1.28-5.18, p0.01). Patients without underlying diseases [aOR=0.63; 95% CI=0.43-0.91, p=0.015] and those who were not referred [aOR=0.51; 95% CI=0.31-0.86, p=0] .011] were less likely to be related to misdiagnosis.To improve diagnostic accuracy, hospitals should reorganize patient admission processes, conducted targeted training, develop policy or guidelines targeting factors predisposing to misdiagnosis, and the adopt a diagnostic error prevention culture.

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Factors associated with misdiagnosis of hospitalised patients in general hospitals of Central Uganda

Katongole¹,

Akweongo

DDMO

et al. 2022

Preprint

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Improving Clerkship to Enhance Patients’ Quality of care (ICEPACQ): a baseline study

Pangholi,

Kagoya,

Nsubuga

et al. 2024

BMC Health Serv Res

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Background Proper and complete clerkships for patients have long been shown to contribute to correct diagnosis and improved patient care. All sections for clerkship must be carefully and fully completed to guide the diagnosis and the plan of management; moreover, one section guides the next. Failure to perform a complete clerkship has been shown to lead to misdiagnosis due to its unpleasant outcomes, such as delayed recovery, prolonged inpatient stay, high cost of care and, at worst, death. Objective The objectives of the study were to determine the gap in clerkship, the impact of incomplete clerkship on the length of hospital stay, to explore the causes of the gap in clerkship of the patients and the strategies which can be used to improve clerkship of the patients admitted to, treated and discharged from the gynecological ward in Mbale RRH. Methodology This was a mixed methods study involving the collection of secondary data via the review of patients’ files and the collection of qualitative data via key informant interviews. The files of patients who were admitted from August 2022 to December 2022, treated and discharged were reviewed using a data extraction tool. The descriptive statistics of the data were analyzed using STATA version 15, while the qualitative data were analyzed via deductive thematic analysis using Atlas ti version 9. Results Data were collected from 612 patient files. For qualitative data, a total of 8 key informant interviews were conducted. Social history had the most participants with no information provided at all (83.5% not recorded), with biodata and vital sign examination (20% not recorded) having the least number. For the patients’ biodata, at least one parameter was recorded in all the patients, with the greatest gap noted in terms of recording the nearest health facility of the patient (91% not recorded). In the history, the greatest gap was noted in the history of current pregnancy (37.5% not provided at all); however, there was also a large gap in the past gynecological history (71% not recorded at all), past medical history (71% not recorded at all), past surgical history (73% not recorded at all) and family history (80% not recorded at all). The physical examination revealed the greatest gap in the abdominal examination (43%), with substantial gaps in the general examination (38.5% not recorded at all) and vaginal examination (40.5% not recorded at all), and the vital sign examination revealed the least gap. There was no patient who received a complete clerkship. There was a significant association between clerkships and the length of hospital stay. The causes of the gap in clerkships were multifactorial and included those related to the hospital, those related to the health worker, those related to the health care system and those related to the patient. The strategies to improve the clerkship of patients also included measures taken by health care workers, measures taken by hospitals and measures taken by the government. Conclusion and recommendation There is a gap in the clerkships of patients at the gynecological ward that is recognized by the stakeholders at the ward, with some components of the clerkship being better recorded than others, and no patients who received a complete clerkship. There was a significant association between clerkships and the length of hospital stay. The following is the recommended provision of clerkship tools, such as the standardized clerkship guide and equipment for patient examination, continuous education of health workers on clerkships and training them on how to use the available tools, the development of SOPs for patient clerkships, the promotion of clerkship culture and the supervision of health workers.

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Factors associated with misdiagnosis of hospitalised patients: A mixed method study in five general hospitals of Central Uganda

Katongole¹,

Akweongo

DDMO

et al. 2023

Preprint

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Introduction: Inpatient misdiagnosis is a major public health problem in sub-Saharan Africa, the scope and causes of which are unknown. The purpose of this cross-sectional study, conducted in five hospitals in central Uganda, was to identify the factors associated with inpatient misdiagnosis in general hospitals in central Uganda. Methodology: An explanatory mixed methods cross-sectional study was used. A retrospective review of 2,431 patient records was performed using explicit review methods to determine the extent of patient misdiagnosis and other variables thought to be related to patient misdiagnosis. Any discrepancy between the admission diagnosis made in the emergency room or outpatient clinic and the patient's discharge diagnosis made upon discharge was defined as a misdiagnosis. The diagnoses were classified using the World Health Organization ICD-11. Six clinical staff and six medical staff were interviewed using in-depth interviews (IDIs) in a phenomenological approach to obtain their explanatory account of factors associated with misdiagnosis. A logistic regression and a deductive thematic analysis were carried out on quantitative and qualitative data analyses. The quantitative and qualitative findings of the study were mixed in interpretation. Results: Misdiagnosis was discovered in 223/2431 (9.2%) of the admitted patients' records. Misdiagnosis was associated with the following factors: a patient admitted to Nakaseke hospital [aOR = 1.95, 95% CI = 1.17–3.25, p = 0.01], admission at night [aOR = 3, 95% CI = 1.81–5.02, p0.01], male patient [aOR = 1.89, 95% CI = 1.35–2.64, p0.01], patient's age groups 10–19 [AOR = 2.3, 95% CI = 2.3-9. Misdiagnosis was also linked to multimorbidity (aOR = 4.71, 95% CI = 1.91–11.65, p0.01) and patients with rare diseases (aOR = 2.57, 95% CI = 1.28–5.18, p0.01). Patients with no underlying diseases [aOR = 0.63; 95% CI = 0.43–0.91, p = 0.015] and those who were not referred [aOR = 0.51; 95% CI = 0.31–0.86, p = 0.011] had a lower risk of misdiagnosis. The quantitative findings of significant (p 0.05) and non-significant patient, contextual, disease, and health system factors associated with misdiagnosis were validated by the qualitative findings. Conclusion: To improve diagnostic accuracy, hospitals should reorganize patient admission processes, provide targeted training, create policies or guidelines targeting risk factors for misdiagnosis, and implement a diagnostic error prevention culture that addresses factors related to misdiagnosis in the respective hospitals oriented.

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Prevalence and Classification of Misdiagnosis Among Hospitalised Patients in Five General Hospitals of Central Uganda

Cited by 4 publications

References 26 publications

Factors associated with misdiagnosis of hospitalised patients in general hospitals of Central Uganda

Factors associated with misdiagnosis of hospitalised patients in general hospitals of Central Uganda

Improving Clerkship to Enhance Patients’ Quality of care (ICEPACQ): a baseline study

Factors associated with misdiagnosis of hospitalised patients: A mixed method study in five general hospitals of Central Uganda

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