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acute care (30:1 OP to acute care visits), but • Proportion ambulatory: acute care increasing • Diagnostic as opposed to surgical • Lack of follow up of lab / radiology results Bishop TF JAMA 2011;305(23):2427-2431 doi:10.1001/jama.2011.813 Smith PC. JAMA 2005;293:565-571 Disclosure of Medical Error • Dr Yeung, a dermatologist, had just completed skin biopsy procedures on 2 patients and when he went to get an instrument tray for a third procedure, he realized that none of the instruments he used had been sterilized. He spoke to the clinic staff and looked at the sterilization test strips for all the trays and confirmed that none of the trays were sterile. • Dr Yeung realizes that the risk of infection from the unsterilized equipment is very low, but blood-borne infections such as hepatitis and HIV could be transmitted. His dilemma is whether to tell the patients about the error and, if so, what to say. Levinson W. JAMA. 2016;316(7):764-765. doi:10.1001/jama.2016.9136. What Would You Do Next? 1. Do nothing; the risk for infection is low and telling the patients about the potential problems will cause undue anxiety. 2. Tell the patients there was an “adverse event” and offer a statement of regret. 3. Report it to the department that does root cause analysis of errors so future errors might be prevented. 4. Tell the patients the details of the mistake and apologize. Tell the patients that the hospital will investigate how it happened and that you will inform them of the outcome. Levinson W. JAMA. 2016;316(7):764-765. doi:10.1001/jama.2016.9136. Bottom Line • When errors occur, the patient should be told about the error and an apology provided. Information about errors should never be withheld from patients. • All personnel involved should participate in the review of the error and in solving any systems problems that contributed to the occurrence of the error. • Contact the institution’s quality assurance department, risk management group, and/or malpractice carrier to inform them of the error. How Medical Errors are Reported in the Hospital Setting Physician: - Incident report to Risk Management - Consult with patient safety program Institution: - Patient grievance - Global trigger tool Code 15 Sentinel Event Five Most Misdiagnosed Conditions, 2017 1. Cancer 2. Neurologic / spine 3. Cardiac / stroke 4. Infectious / communicable (2016) 5. Pulmonary (2016) Rule 64B8-13.005, effective 2/29/16. https://www.flrules.org/gateway/notice_Files.asp?ID=17162227. Last accessed 8/1/2017 Diagnostic Errors: System & Provider -Related • Diagnostic errors constituted 29% of malpractice errors – “failure to diagnose” BMJ Qual Saf 2013; Online First 22 Apr 2013 doi:10.1136 1: Failure to Diagnose Breast Cancer • 2nd leading cause of female cancer deaths • 213,000 women diagnosed annually • 41,000 deaths annually • 1 in 8 chance of developing breast CA in woman’s lifetime • Misdiagnosis of breast CA most prevalent reason for physician malpractice lawsuits • 41% breast CA-related claims decided in plaintiff’s favor (vs 29% all claims) 398 Initial Mammogram Findings Of patients ultimately diagnosed with breast CA, 53% had an initial negative mammogram PIAA Breast Cancer Study, 1995-2002 450 Claimants Percentage by Age 74% of misdiagnoses involved pre- and peri-menopausal patients PIAA Breast Cancer Study, 1995-2002 Most Common Physician Issues in Malpractice PIAA Breast Cancer Study, 1995-2002 PIAA Breast Cancer Study, 2015 • Radiologists most common specialty for claims – mammography, followed by OB/GYN, IM, general surgery • Diagnostic errors most common, followed by failure to supervise, delay in performance • In 59% of claims, patients presented with something other than breast cancer as initial reason for medical visit https://www.johnsonlambert.com/news-blog/2014/02/07/new-study-elucidates-impact-breast-cancer-diagnosis-and-treatment-medical Lessons Learned • Any woman of any age can have breast cancer • Any woman of any age must be fully screened • Mammography • If necessary, ultrasound and biopsy • Correlate clinical and radiologic findings • Do not depend on a negative mammogram alone if doubts or concerns by provider or patient