Missed Diagnostic Opportunities
Research type
Research Study
Full title
Missed Diagnostic Opportunities and English general practice: a study to determine their incidence, confounding and contributing factors and potential impact on patients through retrospective review of electronic medical records.
IRAS ID
160671
Contact name
Stephen Campbell
Contact email
Sponsor organisation
University of Manchester
Duration of Study in the UK
1 years, 5 months, 30 days
Research summary
Research Summary
Patient safety and in particular the occurrence of medical errors, has received considerable global attention since the publication of the landmark report ‘To Err is Human’ in 1999. Within the range of possible errors, medication related errors and diagnostic errors have been identified as the most common types of error in the primary care (e.g. general practice) setting. Despite their potential for, and actual significant impact, diagnostic errors (now termed missed diagnostic opportunities (MDOs)) have received relatively limited attention by academic researchers. Data on the numbers, types and causes of such MDOs encountered in general practice are limited and there are no large-scale studies in the UK that provide an accurate measure of MDO and harm rates in UK general practice. From what we do know globally, it seems that MDOs are more common in general practice than in hospitals and there is a wide range of estimates of the actual rate of harm. Recent work in the United States combining data from three large studies puts the MDO rate at 5% of all patient-doctor encounters, but similar data from the UK is lacking. We are proposing a study to estimate the MDO rate in UK general practice. To do this we will need to have GPs reviewing, in a structured manner, a random sample of patient records from a variety of practices. The GPs will be trained to do this and they will not be recording any personal information that would for example be subject to the Data Protection Act (1998). They will only be looking at the clinical information in specific consultations. If there is diagnostic information in that consultation, the GPs will perform a full review of the patient’s record for a year’s period.
Summary of Results
Background: Diagnostic errors are those which may be wrong, missed or delayed. Most often there are clear reasons as to why these errors occurred and could be prevented. We call these types of errors, missed diagnostic opportunities (MDOs). Our study reviewed the electronic heath records of over 2000 people to look at where the MDOs happened and what types of errors they were. We found that errors occur in approximately 5% of all consultations. As millions of patients visit their GP practices each year, this means that several million patients are potentially at risk of avoidable harm from MDOs each year. Errors are most likely to happen due to breakdowns in patient-practitioner encounter such as history taking, examination or ordering tests during the consultation. It is important to stress that the majority of consultations are not harmful and this study shows us where we can best support practitioners in their roles as well as areas of the system that need improvement (e.g. test ordering and interpretation).
REC name
North West - Preston Research Ethics Committee
REC reference
14/NW/1491
Date of REC Opinion
16 Dec 2014
REC opinion
Favourable Opinion