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Medical error
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== Examples == Errors can include misdiagnosis or delayed diagnosis, administration of the wrong [[medication|drug]] to the wrong patient or in the wrong way, giving multiple drugs that [[drug interaction|interact]] negatively, [[surgery]] on an incorrect site, failure to remove all [[retained surgical instruments|surgical instruments]], failure to take the correct blood type into account, or incorrect record-keeping. A 10th type of error is ones which are not watched for by researchers, such as RNs failing to program an IV pump to give a full dose of IV antibiotics or other medication. === Errors in diagnosis === The projected cost of medical errors to the U.S. economy is approximately $20 billion, 87% of which are direct increases in medical costs of providing services to patient affected by medical errors.<ref>{{Cite web|url=https://www.soa.org/globalassets/assets/files/research/projects/research-econ-measurement.pdf|title=The Economic Measurement of Medical Errors|last=Shreve|first=J et al (Milliman Inc.)|date=June 2010|website=Society of Actuaries|access-date=November 11, 2019|archive-date=January 15, 2021|archive-url=https://web.archive.org/web/20210115165754/https://www.soa.org/globalassets/assets/Files/Research/Projects/research-econ-measurement.pdf|url-status=live}}</ref> Medical errors can increase average hospital costs by as much as $4,769 per patient.<ref>{{Cite journal|last=Arlen|first=Jennifer|date=October 1, 2013|title=Economic Analysis of Medical Malpractice Liability and Its Reform|journal=New York University Law and Economics Working Papers|ssrn=2262792}}</ref> One common type of medical error stems from x-rays and medical imaging: failing to see or notice signs of disease on an image.<ref name="Analysis of Perceptual Expertise in"/> The retrospective "miss" rate among abnormal imaging studies is reported to be as high as 30% (the real-life error rate is much lower, around 4-5%, because not all images are abnormal),<ref>{{cite journal |last1=Berlin |first1=Leonard |title=Accuracy of Diagnostic Procedures: Has It Improved Over the Past Five Decades? |journal=American Journal of Roentgenology |year= 2007 |volume=188 |issue=5 |pages=1173–1178 |doi=10.2214/AJR.06.1270|pmid=17449754 }}</ref> and up to 20% of missed findings result in long-term adverse effects.<ref>{{Cite journal|last=Brady|first=Adrian|date=December 7, 2016|title=Error and discrepancy in radiology: inevitable or avoidable?|journal=Insights into Imaging|volume=8|issue=1|pages=171–182|doi=10.1007/s13244-016-0534-1|pmid=27928712|pmc=5265198|doi-access=free}}</ref><ref>{{Cite journal|last=Brady|first=Adrian|date=January 2012|title=Discrepancy and Error in Radiology: Concepts, Causes and Consequences|journal=Ulster Med J.|volume=81|issue=1|pages=3–9|pmc=3609674|pmid=23536732}}</ref> A large study reported several cases where patients were wrongly told that they were HIV-negative when the physicians erroneously ordered and interpreted HTLV (a closely related virus) testing rather than HIV testing. In the same study, >90% of HTLV tests were ordered erroneously.<ref>{{cite journal |last=Siemieniuk |first=Reed |author2=Fonseca, Kevin |author3=Gill, M. John |title=Using Root Cause Analysis and Form Redesign to Reduce Incorrect Ordering of HIV Tests |journal=Joint Commission Journal on Quality and Patient Safety |date=November 2012 |volume=38 |issue=11 |pages=506–512 |pmid=23173397 |doi=10.1016/S1553-7250(12)38067-7 }}</ref> A 2008 literature review in [[The American Journal of Medicine]] estimated that between 10 and 15% of physician diagnoses are erroneous.<ref>{{cite journal |last1=Berner |first1=Eta S. |last2=Graber |first2=Mark L. |title=Overconfidence as a Cause of Diagnostic Error in Medicine |journal=The American Journal of Medicine |date=May 2008 |volume=121 |issue=5 |pages=S2–S23 |doi=10.1016/j.amjmed.2008.01.001 |pmid=18440350 |doi-access=free }}</ref> Misdiagnosis of lower extremity cellulitis is estimated to occur in 30% of patients, leading to unnecessary hospitalizations in 85% and unnecessary antibiotic use in 92%. Collectively, these errors lead to between 50,000 and 130,000 unnecessary hospitalizations and between $195 and $515 million in avoidable health care spending annually in the United States.<ref>{{cite journal |last1=Weng |first1=Qing Yu |last2=Raff |first2=Adam B. |last3=Cohen |first3=Jeffrey M. |last4=Gunasekera |first4=Nicole |last5=Okhovat |first5=Jean-Phillip |last6=Vedak |first6=Priyanka |last7=Joyce |first7=Cara |last8=Kroshinsky |first8=Daniela |last9=Mostaghimi |first9=Arash |title=Costs and Consequences Associated With Misdiagnosed Lower Extremity Cellulitis |journal=JAMA Dermatology |date=1 February 2017 |volume=153 |issue=2 |pages=141–146 |doi=10.1001/jamadermatol.2016.3816 |pmid=27806170 |s2cid=205110504 |url=http://nrs.harvard.edu/urn-3:HUL.InstRepos:33785925 |access-date=September 8, 2019 |archive-date=August 14, 2024 |archive-url=https://web.archive.org/web/20240814204252/https://dash.harvard.edu/handle/1/33785925 |url-status=live |url-access=subscription }}</ref> === Misdiagnosis of psychological disorders === [[Human female sexuality|Female sexual desire]] sometimes used to be diagnosed as [[female hysteria]].{{citation needed|date=June 2015}} [[Food sensitivity|Sensitivities to foods]] and [[food allergies]] risk being misdiagnosed as the [[eating disorder]] [[orthorexia]]. Studies have found that [[bipolar disorder]] has often been misdiagnosed as [[major depression]]. Its early diagnosis necessitates that clinicians pay attention to the features of the patient's depression and also look for present or prior [[hypomanic]] or [[mania|manic]] symptomatology.<ref name=Bowden2001>{{cite journal |last1=Bowden |first1=Charles L. |title=Strategies to Reduce Misdiagnosis of Bipolar Depression |journal=Psychiatric Services |date=January 2001 |volume=52 |issue=1 |pages=51–55 |doi=10.1176/appi.ps.52.1.51 |pmid=11141528 }}</ref> The misdiagnosis of [[schizophrenia]] is also a common problem. There may be long delays of patients getting a correct diagnosis of this disorder.<ref>{{cite news |title=Schizophrenia Symptoms |publisher=schizophrenia.com |access-date=2008-03-30 |url=http://www.schizophrenia.com/diag.php |archive-date=December 5, 2015 |archive-url=https://web.archive.org/web/20151205115712/http://schizophrenia.com/diag.php |url-status=live }}</ref> [[Delayed sleep phase disorder]] is often confused with: psychophysiological insomnia; [[clinical depression|depression]]; psychiatric disorders such as [[schizophrenia]], [[ADHD|ADHD or ADD]]; other sleep disorders; or [[school refusal]]. Practitioners of [[sleep medicine]] point out the dismally low rate of accurate diagnosis of the disorder, and have often asked for better physician education on sleep disorders.<ref name=Dagan_2005>{{cite journal |vauthors=Dagan Y, Ayalon L |title=Case study: psychiatric misdiagnosis of non-24-hours sleep–wake schedule disorder resolved by melatonin |journal=J Am Acad Child Adolesc Psychiatry |volume=44 |issue=12 |pages=1271–1275 |year=2005 |pmid=16292119 |doi= 10.1097/01.chi.0000181040.83465.48}}</ref> [[Cluster headache]]s are often misdiagnosed, mismanaged, or undiagnosed for many years; they may be confused with [[migraine]], "cluster-like" [[headache]] (or mimics), CH subtypes, other TACs ([[Trigeminal autonomic cephalgia|trigeminal autonomic cephalalgias]]), or other types of primary or secondary headache syndrome.<ref>{{cite journal |last1=van Vliet |first1=J A |last2=Eekers |first2=PJ |last3=Haan |first3=J |last4=Ferrari |first4=MD |last5=Dutch RUSSH Study |first5=Group. |title=Features involved in the diagnostic delay of cluster headache |journal=Journal of Neurology, Neurosurgery & Psychiatry |date=1 August 2003 |volume=74 |issue=8 |pages=1123–1125 |doi=10.1136/jnnp.74.8.1123 |pmid=12876249 |pmc=1738593 }}</ref> Cluster-like head pain may be diagnosed as secondary headache rather than cluster headache.<ref name=IHS>{{cite web |url= http://www.ihs-classification.org/en/02_klassifikation/02_teil1/03.01.00_cluster.html |title= IHS Classification ICHD-II 3.1 Cluster headache |publisher= The International Headache Society |access-date= 2014-01-03 |url-status= dead |archive-url= https://web.archive.org/web/20131103182003/http://www.ihs-classification.org/en/02_klassifikation/02_teil1/03.01.00_cluster.html |archive-date= 3 November 2013 |df= dmy-all }}</ref> Under-recognition of CH by health care professionals is reflected in consistent findings in Europe and the United States that the average time to diagnosis is around seven years.<ref>{{cite journal |last1=Tfelt-Hansen |first1=Peer C. |last2=Jensen |first2=Rigmor H. |title=Management of Cluster Headache |journal=CNS Drugs |date=July 2012 |volume=26 |issue=7 |pages=571–580 |doi=10.2165/11632850-000000000-00000 |pmid=22650381 |s2cid=22522914 }}</ref> [[Asperger syndrome]] and [[autism]] tend to get undiagnosed or delayed recognition and delayed diagnosis<ref>{{cite journal |last1=Brett |first1=Denise |last2=Warnell |first2=Frances |last3=McConachie |first3=Helen |last4=Parr |first4=Jeremy R. |title=Factors Affecting Age at ASD Diagnosis in UK: No Evidence that Diagnosis Age has Decreased Between 2004 and 2014 |journal=Journal of Autism and Developmental Disorders |year=2016 |volume=46 |issue=6 |pages=1974–1984 |doi=10.1007/s10803-016-2716-6 |pmid=27032954 |pmc=4860193 }}</ref><ref>{{cite journal |last1=Lehnhardt |first1=F.-G. |last2=Gawronski |first2=A. |last3=Volpert |first3=K. |last4=Schilbach |first4=L. |last5=Tepest |first5=R. |last6=Vogeley |first6=K. |title=Das psychosoziale Funktionsniveau spätdiagnostizierter Patienten mit Autismus-Spektrum-Störungen – eine retrospektive Untersuchung im Erwachsenenalter |trans-title=Psychosocial functioning of adults with late diagnosed autism spectrum disorders--a retrospective study |language=de |journal=Fortschritte der Neurologie · Psychiatrie |date=15 November 2011 |volume=80 |issue=2 |pages=88–97 |doi=10.1055/s-0031-1281642 |pmid=22086712 |s2cid=25077268 }}</ref> or misdiagnosed.<ref>{{cite journal |last1=Aggarwal |first1=Shilpa |last2=Angus |first2=Beth |title=Misdiagnosis versus missed diagnosis: diagnosing autism spectrum disorder in adolescents |journal=Australasian Psychiatry |date=4 February 2015 |volume=23 |issue=2 |pages=120–123 |doi=10.1177/1039856214568214 |pmid=25653302 |s2cid=43475267 }}</ref> Delayed or mistaken diagnosis can be traumatic for individuals and families; for example, misdiagnosis can lead to medications that worsen behavior.<ref>{{cite journal |last1=Corvin |first1=Aiden |last2=Fitzgerald |first2=Michael |title=Diagnosis and differential diagnosis of Asperger syndrome |journal=Advances in Psychiatric Treatment |year=2001 |volume=7 |issue=4 |pages=310–318 |doi=10.1192/apt.7.4.310 |doi-access=free }}</ref><ref>{{cite journal |last1=Leskovec |first1=Thomas J. |last2=Rowles |first2=Brieana M. |last3=Findling |first3=Robert L. |title=Pharmacological Treatment Options for Autism Spectrum Disorders in Children and Adolescents |journal=Harvard Review of Psychiatry |date=March 2008 |volume=16 |issue=2 |pages=97–112 |doi=10.1080/10673220802075852 |pmid=18415882 |s2cid=26112061 }}</ref> [[Field experiment|Field trials]] of the ''[[DSM-5|Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition]]'' (DSM-5) included "[[test-retest reliability]]" which involved different clinicians doing independent evaluations of the same patient—a new approach to the study of diagnostic reliability.<ref>{{cite web|url=http://www.dsm5.org/Documents/Reliability_and_Prevalence_in_DSM-5_Field_Trials_1-12-12.pdf |title=Reliability and Prevalence in the DSM-5 Field Trials |date=January 12, 2012 |access-date=2012-01-13 |archive-url=https://web.archive.org/web/20120131110008/http://www.dsm5.org/Documents/Reliability_and_Prevalence_in_DSM-5_Field_Trials_1-12-12.pdf |archive-date=2012-01-31}}</ref> === Outpatient vs. inpatient === Misdiagnosis is the leading cause of medical error in outpatient facilities. Since the National Institute of Medicine's 1999 [https://web.archive.org/web/20100726200809/http://iom.edu/~/media/Files/Report%20Files/1999/To-Err-is-Human/To%20Err%20is%20Human%201999%20%20report%20brief.pdf report], "To Err is Human," found up to 98,000 hospital patients die from preventable medical errors in the U.S. each year, government and private sector efforts have focused on inpatient safety. === Medical prescriptions === {{Main|Medical prescription}} While in 2000 the Committee on Quality of Health Care in America affirmed medical mistakes are an "unavoidable outcome of learning to practice medicine",<ref>{{cite book | author = Linda T. Kohn| author2 = Janet M. Corrigan | author3 = Molla S. Donaldson | pmid = 25077248 | title = To Err is Human: Building a Safer Health System | doi = 10.17226/9728 | year = 2000| isbn = 978-0-309-26174-6 }}</ref> at 2019 the commonly accepted link between prescribing skills and [[clinical clerkships]] was not yet demonstrated by the available data<ref name ="10.29313/gmhc.v7i1.4069" /> and in the U.S. [[Medical prescription#Legibility of handwritten prescriptions|legibility of handwritten prescriptions]] has been indirectly responsible for at least 7,000 deaths annually.<ref name="courtcase">{{Cite web|url=https://www.tdi.texas.gov/appeals/1999cases/991681r.pdf|title=APPEAL NO. 991681 Texas v. Dr. K|access-date=2020-04-16|archive-date=January 8, 2021|archive-url=https://web.archive.org/web/20210108050746/https://www.tdi.texas.gov/appeals/1999cases/991681r.pdf|url-status=live}}</ref> Prescription errors concern ambiguous abbreviations, the right spelling of the full name of drugs: improper use of the nomenclature, of decimal points, unit or rate expressions; legibility and proper instructions; miscalculations of the [[posology]] (quantity, route and frequency of administration, duration of the treatment, dosage form and dosage strength); lack of information about patients (e.g. [[allergy]], declining [[renal function]]) or reported in the medical document.<ref name ="10.29313/gmhc.v7i1.4069">{{cite journal | author = Raden Anita Indriyanti | author2 = Fajar Awalia Yulianto | author3 = Yuke Andriane | url = https://ejournal.unisba.ac.id/index.php/gmhc/article/view/4069 | title = Prescription Writing Errors in Clinical Clerkship among Medical Students | pages = 41–42 | doi = 10.29313/gmhc.v7i1.4069 | format = PDF | journal = Global Medical and Health Communication | year = 2019 | volume = 7 | via = DOAJ | issn = 2301-9123 | oclc = 8186593909 | archive-url = https://web.archive.org/web/20200926142205/https://ejournal.unisba.ac.id/index.php/gmhc/article/view/4069/pdf | archive-date = September 26, 2020 | url-status = live| doi-access = free }}</ref> There were an estimated 66 million clinically significant medication errors in the British NHS in 2018. The resulting adverse drug reactions are estimated to cause around 700 deaths a year in England and to contribute to around 22,000 deaths a year. The British researchers did not find any evidence that error rates were lower in other countries, and the global cost was estimated at $42 billion per year.<ref>{{cite news |last1=Elliott |first1=Rachel |title=PREVALENCE AND ECONOMIC BURDEN OF MEDICATION ERRORS IN THE NHS IN ENGLAND |url=https://www.bpsassessment.com/wp-content/uploads/2020/06/1.-Prevalence-and-economic-burden-of-medication-errors-in-the-NHS-in-England-1.pdf |access-date=19 June 2022 |agency=Policy Research Unit in Economic Evaluation of Health & Care Interventions |publisher=University of Sheffield |date=22 February 2018 |archive-date=September 26, 2022 |archive-url=https://web.archive.org/web/20220926082420/https://www.bpsassessment.com/wp-content/uploads/2020/06/1.-Prevalence-and-economic-burden-of-medication-errors-in-the-NHS-in-England-1.pdf |url-status=live }}</ref> Medication errors in hospital include omissions, delayed dosing and incorrect medication administrations. Medication errors are not always readily identified, but can be reported using case note reviews or incident reporting systems.<ref name="s605">{{cite journal | last1=Mill | first1=Deanna | last2=Bakker | first2=Michael | last3=Corre | first3=Lauren | last4=Page | first4=Amy | last5=Johnson | first5=Jacinta | title=A comparison between Parkinson's medication errors identified through retrospective case note review versus via an incident reporting system during hospital admission | journal=International Journal of Pharmacy Practice | volume=28 | issue=6 | date=2020-11-06 | issn=0961-7671 | doi=10.1111/ijpp.12668 | pages=663–666| pmid=32844477 }}</ref> There are pharmacist-led interventions that can reduce the incident of medication error.<ref>{{cite journal | doi=10.1002/jppr.1699 | title=The impact of pharmacist-led strategies implemented to reduce errors related to cancer therapies: A systematic review | year=2020 | last1=Coutsouvelis | first1=John | last2=Siderov | first2=Jim | last3=Tey | first3=Amanda Y. | last4=Bortz | first4=Hadley D. | last5=o'Connor | first5=Shaun R. | last6=Rowan | first6=Gail D. | last7=Vasileff | first7=Hayley M. | last8=Page | first8=Amy T. | last9=Percival | first9=Mia A. | journal=Journal of Pharmacy Practice and Research | volume=50 | issue=6 | pages=466–480 | s2cid=229332634 | doi-access=free }}</ref> [[Electronic prescribing]] has been shown to reduce prescribing errors by up to 30%.<ref>{{cite journal |last1=Donyai |first1=Parastou |title=The effects of electronic prescribing on the quality of prescribing |journal=British Journal of Clinical Pharmacology |publisher=Br J Clin Pharmacol |date=February 2008|volume=65 |issue=2 |pages=230–237 |doi=10.1111/j.1365-2125.2007.02995.x |pmid=17662088 |pmc=2253693 }}</ref>
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