Types of misdiagnosis that can harm patients during COVID-19

As healthcare systems handle the challenges presented by the COVID-19 pandemic, the risk of misdiagnosing a patient increases.

Health safety experts at Baylor College of Medicine and Press Ganey Associates LLC in Boston identify eight types of diagnostic errors anticipated due to the pandemic and highlight strategies to minimize them. Their report was published in the Journal of Hospital Medicine.

“All of these misdiagnoses can lead to patient harm from delays in the correct treatment,” said Dr. Hardeep Singh, author and professor of medicine at Baylor and the Center for Innovations in Quality, Effectiveness and Safety (IQuESt). “Testing for COVID-19 has been a problem, but we have also seen new issues emerge such as reports of patients not seeking help due to fear of the pandemic, with delayed diagnosis of heart attacks, stroke diagnoses and typical emergencies.”

“In this challenging time, it is essential to understand the types of diagnostic errors that can occur and build highly reliable systems to help support our clinicians and prevent harm to patients,” said Dr. Tejal Gandhi, the chief safety and transformation officer at Press Ganey.

By studying rapidly evolving literature and news for emerging diagnosis issues, Singh and Gandhi developed names for the eight types of diagnostic errors in an effort to help clinicians, other healthcare personnel and the public identify them:

• Classic: A delayed COVID-19 diagnosis due to lack of accessible tests or tests that read false-negative.
• Anomalous: A COVID-19 patient misdiagnosed as non-COVID when they present uncharacteristic symptoms such as nausea and diarrhea, especially if they lack respiratory symptoms.
• Anchor: Assuming someone has COVID-19 when they may have another illness instead, such as bacterial pneumonia or sinusitis. Singh explains this can make their conditions worse, especially if the patient requires antibiotics.
• Secondary: Because COVID-19 is a new virus, clinicians may miss underlying or secondary conditions that it can cause, like blood clot related lung complications. New inflammation syndromes in children are just being described, for example.
• Acute Collateral: Because some people fear venturing into hospitals or clinics due to potential exposure, many are remaining home even when they have stroke or heart attack symptoms.
• Chronic Collateral: Some patients may have a delayed diagnosis of a serious condition due to appointment cancellations and the rescheduling of elective procedures like biopsies or mammograms.
• Strain: For places experiencing a surge, non-COVID patients may be overlooked because of the focus on COVID-19.
• Unintended: The risk of misdiagnosing a patient because of indirect contact with them through telehealth or barriers presented by personal protective equipment.

Singh and Gandhi propose solutions to help prevent these types of diagnostic errors through technology, communication, teamwork and organizational strategies.

“There is no magic pill that is going to solve this, but we can definitely improve the work system we practice in and seek help when needed,” Singh said.

• Use up-to-date technology that helps healthcare providers make better decisions and scale safety practices to address possible risks to patients.
• Address communication issues by encouraging patients to discuss any concerns they might have and by ensuring follow-up appointments via telehealth visits.
• Use buddy systems in the hospital or clinic, especially for less experienced physicians or healthcare workers so that they can easily ask for advice.
• Minimize stress and anxiety in the workplace by offering counseling and peer support. Encourage staff to ask questions, seek help and report concerns.
• Create learning systems and networks by sharing data and knowledge surrounding newly discovered risks so that errors can be minimized.

Singh emphasizes that it also is essential for the public to seek medical assistance and not remain home if they are experiencing concerning symptoms.

“One of the big messages for the public is the acute and chronic collateral misdiagnoses that are occurring due to the pandemic,” he said. “If you are having new symptoms that are of concern, you must seek help, whether it’s through telehealth or in person.”

Singh is funded in part by the Agency for Healthcare Research and Quality (R01HS27363), the CanTest Research Collaborative funded by a Cancer Research UK Population Research Catalyst award (C8640/A23385) and the Gordon and Betty Moore Foundation.