Missed Diagnostic Opportunities in UK General Practice: A Study to determine their Incidence, Contributing factors and Impact

Conference:

SAPC ASM 2016 - Dublin

Talk Code:

P2.14

Presenter:

Rebecca Lauren Morris

Co-authors:

Sudeh Cheraghi-Sohi1 Hardeep Singh2, David Reeves1, Jill Stocks1, Aneez Esmail1, Carl de Wet3 and Stephen Campbell1

Author institutions:

1NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, 2. Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, 3 Logan Hyperdome Doctors

Problem

Patient safety research has increasingly identified diagnostic errors as a common type of error in primary care. The US Institute of Medicine recently released a report, “Improving Diagnosis in Health Care”, which suggests that all of us will likely experience a diagnostic error in our lifetime. Diagnostic error has remained an under measured area of patient safety research until recently. Moreover, there have been no large-scale epidemiological studies that reliably quantify error or harm rates in UK primary care. This study aims to determine the incidence of Missed Diagnostic Opportunities (MDOs) in English General Practice.

Approach

The study involves a 2-phase retrospective record review of 5000 patient records selected from 50 general practices. Trained General Practitioners will review records of patients over 18 years who had face-to-face consultations and were continuously registered with the study practices between 1st April 2013 and 31st March 2015. We will exclude records of temporary residents, nursing home residents when their full records are not kept at the surgery or if the index consultation was not attended by the patient. The primary outcome is an incidence rate of MDOs in general practice. Secondary outcomes will identify the confounding and contributing factors that lead to MDOS and the impact, or potential impact of the MDOs.

Findings

This is an ongoing study. Thus far, Phase 1 has begun with 15 practices having been enrolled to review and 1500 patient records being reviewed.

Consequences

This is the first large-scale epidemiological study in the UK to identify a rate of MDOs and is the first step in developing practices and interventions to reduce harm and improve patient safety in this area.

Submitted by:

Rebecca Lauren Morris

Funding acknowledgement:

This study was funded by the National Institute for Health Research Greater Manchester Primary Care Patient Safety Translational Research Centre. The views expressed in this article are those of the authors and not necessarily those of the NHS, NIHR or the Department of Health.