PT  - JOURNAL ARTICLE
AU  - Kwan, Janice L.
AU  - Calder, Lisa A.
AU  - Bowman, Cara L.
AU  - MacIntyre, Anna
AU  - Mimeault, Richard
AU  - Honey, Liisa
AU  - Dunn, Cynthia
AU  - Garber, Gary
AU  - Singh, Hardeep
TI  - Characteristics and contributing factors of diagnostic error in surgery: analysis of closed medico-legal cases and complaints in Canada
AID  - 10.1503/cjs.003523
DP  - 2024 Feb 06
TA  - Canadian Journal of Surgery
PG  - E58--E65
VI  - 67
IP  - 1
4099  - http://canjsurg.ca/content/67/1/E58.short
4100  - http://canjsurg.ca/content/67/1/E58.full
SO  - CAN J SURG2024 Feb 06; 67
AB  - Background: Diagnostic errors lead to patient harm; however, most research has been conducted in nonsurgical disciplines. We sought to characterize diagnostic error in the pre-, intra-, and postoperative surgical phases, describe their contributing factors, and quantify their impact related to patient harm.Methods: We performed a retrospective analysis of closed medico-legal cases and complaints using a database representing more than 95% of all Canadian physicians. We included cases if they involved a legal action or complaint that closed between 2014 and 2018 and involved a diagnostic error assigned by peer expert review to a surgeon.Results: We identified 387 surgical cases that involved a diagnostic error. The surgical specialties most often associated with diagnostic error were general surgery (n = 151, 39.0%), gynecology (n = 71, 18.3%), and orthopedic surgery (n = 48, 12.4%), but most surgical specialties were represented. Errors occurred more often in the postoperative phase (n = 171, 44.2%) than in the pre- (n = 127, 32.8%) or intra-operative (n = 120, 31.0%) phases of surgical care. More than 80% of the contributing factors for diagnostic errors were related to providers, with clinical decision-making being the principal contributing factor. Half of the contributing factors were related to the health care team (n = 194, 50.1%), the most common of which was communication breakdown. More than half of patients involved in a surgical diagnostic error experienced at least moderate harm, with 1 in 7 cases resulting in death.Conclusion: In our cohort, diagnostic errors occurred in most surgical disciplines and across all surgical phases of care; contributing factors were commonly attributed to provider clinical decision-making and communication breakdown. Surgical patient safety efforts should include diagnostic errors with a focus on understanding and reducing errors in surgical clinical decision-making and improving communication.