Background: Diagnostic errors (DE), defined as missed opportunities to make a correct or timely diagnosis based on the available evidence, are a critical but understudied cause of patient harm. While previous efforts have focused on examining the incidence and factors contributing to DEs in ambulatory and emergency room settings, fewer studies have examined incidence of [...]

Background: Previous studies have identified racial differences in sepsis incidence and sepsis mortality. Some evidence points towards differential treatment and subsequent sepsis outcomes in Black versus White patients. However, it is unclear to what extent racial differences exist in presentation and subsequent interpretation of complaints in the early phase of sepsis. Using History and Physical [...]

Background: Community-acquired pneumonia (CAP) is the most common infectious diagnosis necessitating adult hospitalization in the United States (US). Timely diagnosis of CAP is important to improve patient outcomes. However, overdiagnosis of CAP, or treatment of CAP despite inadequate signs or symptoms of CAP, may also pose a significant threat to patient safety. Potential harm of [...]

Case Presentation: A 78 year old female with history of chronic kidney disease (CKD) stage 4, diet-controlled diabetes, and bilateral idiopathic ureteral obstruction s/p percutaneous nephrostomies presented with 5 days of changes in urine color. Initially, the patent reported a darker and thicker appearance to her urine that transitioned to a purple color. She denied [...]

Case Presentation: 71-year-old female with history of DM2, HTN, breast carcinoma in situ status post mastectomy, B-cell lymphoma (R-CHOP in 2016 & RT, currently in remission), autoimmune hepatitis related cirrhosis on Azathioprine presented to the hospital with a 4-day history of progressively worsening productive cough, mild hemoptysis, fever and shortness of breath. In the Emergency [...]

Case Presentation: An 82-year-old woman with hypertension, diabetes, and a renal transplant recipient for diabetic nephropathy was admitted with three days of chills, cough, dyspnea, and increased urinary frequency. Her urinalysis was positive for pyuria and hematuria, and she was diagnosed with cystitis. Chest radiograph on admission was read as clear by radiology. She was [...]

Background: The COVID-19 pandemic required physicians to care for a new disease with uncertain and evolving characteristics while also adhering to physical and social distancing practices, and under conditions of extreme duress – all factors likely to lead to missed or delayed diagnoses among patients admitted ‘under investigation’ for COVID-19. Methods: We carried out a [...]

Case Presentation: A 41-year-old male presented with three-day history of fever with chills, headache, and emesis. His prior medical history was significant for splenomegaly with thrombocytopenia of unclear etiology for several years. He had recent travel throughout the United States and the United Kingdom. He also noted remote travel to East Africa, China and Chile [...]

Background: The diagnostic process is dynamic – as additional information becomes available and diagnostic uncertainty is addressed, diagnosis evolves. An accurate and updated problem list in the electronic health record (EHR) should reflect modifications and refinement of the working diagnosis (1). Anecdotally, this does not happen: many providers do not the update problem list or [...]

Background: Diagnostic errors (DE), defined as missed opportunities to make a correct or timely diagnosis based on the available evidence, are a critical but understudied cause of patient harm. While previous efforts have focused on examining the incidence and factors contributing to DEs in ambulatory and emergency room settings, fewer studies have examined incidence of [...]