Study Shows Most Common ICU Diagnosis Errors

One in four ICU patient deaths occurs due to misdiagnosis according to a study implemented by Johns Hopkins University School of Medicine and published last month by BMJ Quality.  The study linked the findings of 31 international papers that examined 5,863 autopsies performed in 12 countries including the United States, Brazil, France, Germany and Slovenia.

The autopsy reports that were researched found that 28% of patients had at least one missed diagnosis, and in 8% of those cases, the error was serious enough to be the cause of death.  Autopsies examined in the study and performed on patients who died in ICUs in the United States indicated that between 22,600 and 40,500 adults may have died due to a missed diagnosis.

The most serious conditions found to be misdiagnosed most frequently were: heart attack, pneumonia, pulmonary embolism and aspergillosis.  These four conditions accounted for one-third of missed illnesses.  For instance, a diagnosis of pulmonary embolism (a clot in lung) was often assigned when the patient had actually suffered a heart attack.  In other situations, when a patient arrived at the hospital in acute respiratory distress, the patient was treated for a respiratory infection while that patient should have been assigned a very different treatment that is protocol for the fungal infection, aspergillosis.

Additional research has shown that even more patients suffer harm due to diagnosis errors made by critical care teams.

Lead author of the study, Dr. Bradford Winters, associate professor of anesthesiology and critical care medicine at Johns Hopkins, suggests that the most telling component of the study was that the primary focus of the papers examined appeared to be on the decline of hospital autopsies instead of the fact that thousands of patients are dying as a result of diagnosis errors.

“The papers seem to be complaining about that, rather than recognizing that we’re missing all these diagnoses, and we need to fix the system so we don’t miss them.  Just increasing the number of autopsies isn’t going to fix the problem because these patients are already dead,” Winters said.

Winters acknowledges that fixing the problem of inaccurate diagnosis is not going to be easy and may require technological improvements that are costly and possibly unavailable at this time.  He does, however, suggest steps that hospitals can take right away to improve diagnostic accuracy and reduce mortality:

  • Cultivate and employ more intensivists.  Today, there are only 7,000 board certified intensivists in the U.S.
  • Adhere more adamantly to the recommended 1- to-1 nurse- to-patient ratio for the ICU.
  • Develop and use more checklists or goal sheets as a way of closing information gaps.
  • Concentrate on finding remedies for common problems like alarm fatigue and distractions and noise.

The bottom line is that, while autopsies do help determine cause of death and point to common mistakes, ICU teams need diagnostic help.  The job of the ICU staff is already complicated by the fact that their patients are typically unable to assist in the diagnostic process because they are often intubated, sedated or unconscious.  So, it is critical that more effort is put into measuring the impact of diagnostic errors and developing reduction strategies.

Diabetic Med Adherence Could Save $8.3 Billion

A new study, published in the August issue of Health Affairs, indicated that stricter adherence to drug regimens by our nation’s diabetics could save an estimated $8.3 billion in annual healthcare costs while reducing diabetics’ emergency department visits and hospitalizations by 13 percent.

Researchers estimated that by sticking to their medication regimens, diabetics could avoid 699,000 ED visits as well as 341,000 hospitalizations for a combined savings of over $4.7 billion.  The study abstract indicated that another $3.6 billion in savings could be realized if no diabetics stopped taking their prescribed medications. (During the study, one in four diabetics stopped taking their medications at some point increasing their risk of hospitalization by approximately 15 percent.)

Total adherence by patients with diabetes could save $3.93 billion in Medicare costs according to researchers.  Improved adherence, researchers indicated, might mean that a facility with 10,000 Medicare beneficiaries could save as much as $1.1 million annually in ED and hospital costs.

Researchers offered several suggestions for motivating patients to hold fast to their prescribed treatment regimens including lowering copayments for certain drugs and utilizing advanced technologies that facilitate improved oversight and physician/patient communication. For instance, the Food and Drug Administration recently approved the use of implantable microchips that confirm when medications have been ingested.  The chips react with digestive juices and send a signal to a skin patch which can then be relayed to a smartphone and/or a doctor’s office. The chip later dissolves.

In another effort to improve outcomes, Geisinger Health System announced in June that they are collaborating with Merck pharmaceuticals to develop a cloud-based application aimed at helping patients adhere to treatment plans and clinical care processes and designed to integrate with any EHR system.