Use of patient complaints to identify diagnosis-related safety concerns: a mixed-method evaluation

Abstract

Background: Patient complaints are associated with adverse events and malpractice claims but underused in patient safety improvement.

Objective: To systematically evaluate the use of patient complaint data to identify safety concerns related to diagnosis as an initial step to using this information to facilitate learning and improvement.

Methods: We reviewed patient complaints submitted to Geisinger, a large healthcare organisation in the USA, from August to December 2017 (cohort 1) and January to June 2018 (cohort 2). We selected complaints more likely to be associated with diagnostic concerns in Geisinger's existing complaint taxonomy. Investigators reviewed all complaint summaries and identified cases as 'concerning' for diagnostic error using the National Academy of Medicine's definition of diagnostic error. For all 'concerning' cases, a clinician-reviewer evaluated the associated investigation report and the patient's medical record to identify any missed opportunities in making a correct or timely diagnosis. In cohort 2, we selected a 10% sample of 'concerning' cases to test this smaller pragmatic sample as a proof of concept for future organisational monitoring.

Results: In cohort 1, we reviewed 1865 complaint summaries and identified 177 (9.5%) concerning reports. Review and analysis identified 39 diagnostic errors. Most were categorised as 'Clinical Care issues' (27, 69.2%), defined as concerns/questions related to the care that is provided by clinicians in any setting. In cohort 2, we reviewed 2423 patient complaint summaries and identified 310 (12.8%) concerning reports. The 10% sample (n=31 cases) contained five diagnostic errors. Qualitative analysis of cohort 1 cases identified concerns about return visits for persistent and/or worsening symptoms, interpersonal issues and diagnostic testing.

Conclusions: Analysis of patient complaint data and corresponding medical record review identifies patterns of failures in the diagnostic process reported by patients and families. Health systems could systematically analyse available data on patient complaints to monitor diagnostic safety concerns and identify opportunities for learning and improvement.

Keywords: diagnostic errors; health services research; healthcare quality improvement; patient safety.