دورية أكاديمية
Characteristics and contributing factors of diagnostic error in surgery: analysis of closed medico-legal cases and complaints in Canada.
| العنوان: | Characteristics and contributing factors of diagnostic error in surgery: analysis of closed medico-legal cases and complaints in Canada. |
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| المؤلفون: | Kwan JL; From the Department of Medicine, Sinai Health and University of Toronto, Toronto, Ont. (Kwan); Safe Medical Care Research, Canadian Medical Protective Association, Ottawa, Ont. (Calder, Bowman, MacIntyre, Mimeault, Honey, Dunn, Garber); the Department of Emergency Medicine and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ont. (Calder); the Canadian Association of General Surgeons, Kanata, Ont. (Mimeault); the Department of Obstetrics and Gynecology, Queensway Carleton Hospital, Ottawa, Ont. (Honey); the Department of Medicine and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ont. (Garber); Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center (Singh); and Baylor College of Medicine, Houston, TX, USA (Singh). janice.kwan@utoronto.ca., Calder LA; From the Department of Medicine, Sinai Health and University of Toronto, Toronto, Ont. (Kwan); Safe Medical Care Research, Canadian Medical Protective Association, Ottawa, Ont. (Calder, Bowman, MacIntyre, Mimeault, Honey, Dunn, Garber); the Department of Emergency Medicine and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ont. (Calder); the Canadian Association of General Surgeons, Kanata, Ont. (Mimeault); the Department of Obstetrics and Gynecology, Queensway Carleton Hospital, Ottawa, Ont. (Honey); the Department of Medicine and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ont. (Garber); Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center (Singh); and Baylor College of Medicine, Houston, TX, USA (Singh)., Bowman CL; From the Department of Medicine, Sinai Health and University of Toronto, Toronto, Ont. (Kwan); Safe Medical Care Research, Canadian Medical Protective Association, Ottawa, Ont. (Calder, Bowman, MacIntyre, Mimeault, Honey, Dunn, Garber); the Department of Emergency Medicine and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ont. (Calder); the Canadian Association of General Surgeons, Kanata, Ont. (Mimeault); the Department of Obstetrics and Gynecology, Queensway Carleton Hospital, Ottawa, Ont. (Honey); the Department of Medicine and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ont. (Garber); Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center (Singh); and Baylor College of Medicine, Houston, TX, USA (Singh)., MacIntyre A; From the Department of Medicine, Sinai Health and University of Toronto, Toronto, Ont. (Kwan); Safe Medical Care Research, Canadian Medical Protective Association, Ottawa, Ont. (Calder, Bowman, MacIntyre, Mimeault, Honey, Dunn, Garber); the Department of Emergency Medicine and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ont. (Calder); the Canadian Association of General Surgeons, Kanata, Ont. (Mimeault); the Department of Obstetrics and Gynecology, Queensway Carleton Hospital, Ottawa, Ont. (Honey); the Department of Medicine and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ont. (Garber); Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center (Singh); and Baylor College of Medicine, Houston, TX, USA (Singh)., Mimeault R; From the Department of Medicine, Sinai Health and University of Toronto, Toronto, Ont. (Kwan); Safe Medical Care Research, Canadian Medical Protective Association, Ottawa, Ont. (Calder, Bowman, MacIntyre, Mimeault, Honey, Dunn, Garber); the Department of Emergency Medicine and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ont. (Calder); the Canadian Association of General Surgeons, Kanata, Ont. (Mimeault); the Department of Obstetrics and Gynecology, Queensway Carleton Hospital, Ottawa, Ont. (Honey); the Department of Medicine and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ont. (Garber); Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center (Singh); and Baylor College of Medicine, Houston, TX, USA (Singh)., Honey L; From the Department of Medicine, Sinai Health and University of Toronto, Toronto, Ont. (Kwan); Safe Medical Care Research, Canadian Medical Protective Association, Ottawa, Ont. (Calder, Bowman, MacIntyre, Mimeault, Honey, Dunn, Garber); the Department of Emergency Medicine and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ont. (Calder); the Canadian Association of General Surgeons, Kanata, Ont. (Mimeault); the Department of Obstetrics and Gynecology, Queensway Carleton Hospital, Ottawa, Ont. (Honey); the Department of Medicine and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ont. (Garber); Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center (Singh); and Baylor College of Medicine, Houston, TX, USA (Singh)., Dunn C; From the Department of Medicine, Sinai Health and University of Toronto, Toronto, Ont. (Kwan); Safe Medical Care Research, Canadian Medical Protective Association, Ottawa, Ont. (Calder, Bowman, MacIntyre, Mimeault, Honey, Dunn, Garber); the Department of Emergency Medicine and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ont. (Calder); the Canadian Association of General Surgeons, Kanata, Ont. (Mimeault); the Department of Obstetrics and Gynecology, Queensway Carleton Hospital, Ottawa, Ont. (Honey); the Department of Medicine and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ont. (Garber); Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center (Singh); and Baylor College of Medicine, Houston, TX, USA (Singh)., Garber G; From the Department of Medicine, Sinai Health and University of Toronto, Toronto, Ont. (Kwan); Safe Medical Care Research, Canadian Medical Protective Association, Ottawa, Ont. (Calder, Bowman, MacIntyre, Mimeault, Honey, Dunn, Garber); the Department of Emergency Medicine and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ont. (Calder); the Canadian Association of General Surgeons, Kanata, Ont. (Mimeault); the Department of Obstetrics and Gynecology, Queensway Carleton Hospital, Ottawa, Ont. (Honey); the Department of Medicine and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ont. (Garber); Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center (Singh); and Baylor College of Medicine, Houston, TX, USA (Singh)., Singh H; From the Department of Medicine, Sinai Health and University of Toronto, Toronto, Ont. (Kwan); Safe Medical Care Research, Canadian Medical Protective Association, Ottawa, Ont. (Calder, Bowman, MacIntyre, Mimeault, Honey, Dunn, Garber); the Department of Emergency Medicine and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ont. (Calder); the Canadian Association of General Surgeons, Kanata, Ont. (Mimeault); the Department of Obstetrics and Gynecology, Queensway Carleton Hospital, Ottawa, Ont. (Honey); the Department of Medicine and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ont. (Garber); Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center (Singh); and Baylor College of Medicine, Houston, TX, USA (Singh). |
| المصدر: | Canadian journal of surgery. Journal canadien de chirurgie [Can J Surg] 2024 Feb 06; Vol. 67 (1), pp. E58-E65. Date of Electronic Publication: 2024 Feb 06 (Print Publication: 2024). |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Canadian Medical Association Country of Publication: Canada NLM ID: 0372715 Publication Model: Electronic-Print Cited Medium: Internet ISSN: 1488-2310 (Electronic) Linking ISSN: 0008428X NLM ISO Abbreviation: Can J Surg Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: Ottawa : Canadian Medical Association Original Publication: Toronto, Canadian Medical Assn. |
| مواضيع طبية MeSH: | Malpractice* , Surgeons*, Humans ; Retrospective Studies ; Canada/epidemiology ; Diagnostic Errors |
| مستخلص: | Background: Diagnostic errors lead to patient harm; however, most research has been conducted in nonsurgical disciplines. We sought to characterize diagnostic error in the pre-, intra-, and postoperative surgical phases, describe their contributing factors, and quantify their impact related to patient harm. Methods: We performed a retrospective analysis of closed medico-legal cases and complaints using a database representing more than 95% of all Canadian physicians. We included cases if they involved a legal action or complaint that closed between 2014 and 2018 and involved a diagnostic error assigned by peer expert review to a surgeon. Results: We identified 387 surgical cases that involved a diagnostic error. The surgical specialties most often associated with diagnostic error were general surgery ( n = 151, 39.0%), gynecology ( n = 71, 18.3%), and orthopedic surgery ( n = 48, 12.4%), but most surgical specialties were represented. Errors occurred more often in the postoperative phase ( n = 171, 44.2%) than in the pre- ( n = 127, 32.8%) or intra-operative ( n = 120, 31.0%) phases of surgical care. More than 80% of the contributing factors for diagnostic errors were related to providers, with clinical decision-making being the principal contributing factor. Half of the contributing factors were related to the health care team ( n = 194, 50.1%), the most common of which was communication breakdown. More than half of patients involved in a surgical diagnostic error experienced at least moderate harm, with 1 in 7 cases resulting in death. Conclusion: In our cohort, diagnostic errors occurred in most surgical disciplines and across all surgical phases of care; contributing factors were commonly attributed to provider clinical decision-making and communication breakdown. Surgical patient safety efforts should include diagnostic errors with a focus on understanding and reducing errors in surgical clinical decision-making and improving communication. Competing Interests: Competing interests:: Lisa Calder, Cara Bowman, Anna MacIntyre, Richard Mimeault, Liisa Honey, Cynthia Dunn, and Gary Garber are employees of the Canadian Medical Protective Association. Lisa Calder is board chair with Salus Global and sits on the board of the Medical Professional Liability Association. Gary Garber reports funding from the Canadian Institutes of Health Research. Hardeep Singh reports funding from the Department of Veterans Affairs, the Veterans Affairs National Center for Patient Safety, and the Agency for Healthcare Research and Quality. Hardeep Singh serves as cochair of the Leapfrog Diagnostic Excellence Advisory Group. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government. No other competing interests declared. (© 2024 CMA Impact Inc. or its licensors.) |
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| تواريخ الأحداث: | Date Created: 20240206 Date Completed: 20240212 Latest Revision: 20240212 |
| رمز التحديث: | 20240213 |
| مُعرف محوري في PubMed: | PMC10852193 |
| DOI: | 10.1503/cjs.003523 |
| PMID: | 38320779 |
| قاعدة البيانات: | MEDLINE |
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Full Text Finder | تدمد: | 1488-2310 |
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| DOI: | 10.1503/cjs.003523 |