Improving Diagnosis in Danish Health Care

New report: Diagnostic error in Danish Healthcare: Mapping data from the Patient Compensation Association

Internationally, there is a growing awareness on diagnostic errors as a major – and so far, overlooked patient safety problem.

Danish Society for Patient Safety and Danish Patient Compensation Association has analyzed the area more closely in Danish context. The analysis is based on records from the Patient Compensation Association (compensable patient injuries).

Report (in Danish)

To systematize the analysis, we developed/adapted a tool, making it possible to identify what phase in the diagnostic process was affected by error.

The Analysis

A quantitative and a qualitative analysis has been carried out on data from the Patient Compensation Association.

The quantitative analysis calculated the frequency of diagnostic error leading to compensation, and what illnesses and medical specialities was most often involved.

During the qualitative analysis 225 cases from the Danish Patient Compensation Association records were audited, all of them recognized by the association as a diagnostic error leading to compensation. The records contain expert argumentation for the compensation and all background material, medical charts, hospital records, lab results, x-ray-pictures etc.

To systematize the analysis, we developed/adapted a tool, making it possible to identify what phase in the diagnostic process was affected by error. Our tool was translated and adapted from a tool originally designed by the American organization CRICO (The Risk Management Foundation of the Harvard Medical Institutions Incorporated) to analyze and learn from malpractice claims.

Patients representatives and representatives from stakeholder organizations were invited to a workshop to discuss the preliminary results of the analysis (April 2109). Discussion at the workshop led to several ideas on how to improve the diagnostic process.

Subsequently a range of experts and stakeholders has been interviewed to identify possibilities for improvement.

Results from the quantitative analysis

Annually 760 Danish citizens is compensated for injuries caused by diagnostic error. 63 citizens die (mean age: 55 years). These cases only represent a fraction of the true incidence, which is believed to be 2-10 times this number.

Cases related to diagnostic error represent 29 % of compensable patient injuries in the Patient Compensation Associations data.

Five major diseases account for 75 % of diagnosis-related cases: Traumatic lesions, cancer, musculoskeletal conditions, vascular diseases and disease of the alimentary tract.

Orthopedic surgery and general practice are the two medical specialities most often involved in diagnostic error.

Results from the qualitative analysis

The reviewers found:
• • 80 % of cases: error in the initial diagnostic assessment
• • 27 % of cases: error in testing and results processing
• • 33 % of cases: error in follow up and coordination

• • 40 % of cases was related to emergency care (medical conditions or injury)
• • 25 % of cases was related to cancer diagnostics

Reviewers identified several examples of “overshadowing”, where existing conditions or serious injury obstructed the diagnosis of new illness or less serious – but significant symptoms.

Several examples of unnecessary (and harmful) surgery were identified carried out on the wrong premises of an erroneous diagnosis.

Summary and conclusion

Analysis of the data from the Patient Compensation Association has shown, that diagnostic errors occur frequently in Danish healthcare.

This is in consistence with similar finding in US and in Sweden.

We believe that analysis of cases about diagnostic error hold an untapped potential for learning and improving the diagnostic process. Data can be utilized to generate knowledge about patterns behind and causes of diagnostic error in a systems perspective.

Data have been presented for relevant stakeholders in Danish health care, and this process already has generated new ideas for improving the diagnostic process in Danish health care.

The Danish Society for Patient Safety plan to build on these data in future efforts to improve and support the diagnostic process.

National Academies of Sciences, Engineering, and Medicine. 2015. Improving Diagnosis in Health Care. Washington, DC: The National Academies Press.

Malpractice Risks in the Diagnostic Process, Annual Benchmarking Report 2014, CRICO

5. december 2019