Understanding How, Where, and Why

Diagnostic Errors Occur

"We can reduce medication errors by including a key piece of information that is currently missing from prescriptions: the reason for the medication."

Gordon D. Schiff, M.D., Associate Director of Brigham and Women’s Center for Patient Safety Research and Practice and Associate Professor at Harvard Medical School, is a patient safety pioneer who has used funding from AHRQ to bring about a better understanding of diagnostic errors, create systems to identify and minimize them, and improve the process of prescribing medications. Over the past 15 years, Dr. Schiff’s AHRQ-funded work has advanced safety in a variety of settings, from ambulatory care centers to the urban medical centers where he has worked for decades.

A general internist, Dr. Schiff’s career began at Chicago’s Cook County Hospital, where he directed the general medical clinic and served as a Professor of Medicine at Rush Medical School, Chicago. While at Cook County, Dr. Schiff was a principal investigator for a multi-year, AHRQ-funded patient safety grant that focused on diagnostic errors, known as the Diagnostic Evaluation and Education Research (DEER) Project.

Findings from this project shed new light on the magnitude, type, and patterns of diagnostic errors. Nearly 600 diagnostic errors were reported by physicians surveyed by Dr. Schiff, and more than a quarter of them were major. Nearly half (44 percent) of the errors occurred during testing and nearly a third (32 percent) during clinician assessment. Using this information, Dr. Schiff and colleagues developed an error classification system that defined and grouped cases by diagnosis and error type. The DEER Taxonomy Chart Audit Tool helps reveal patterns of diagnostic failure and highlights areas for targeted improvement.

More recently, Dr. Schiff served as clinical research director of a 4-year AHRQ-funded project focusing on improving safety in ambulatory settings. The PROMISES (Proactive Reduction in Outpatient Malpractice: Improving Safety, Efficiency, and Satisfaction) project produced findings based on 7,000 malpractice claims from two major carriers. It revealed that the large majority (72 percent) of primary care malpractice cases were due to errors of diagnosis. The project team created a collaborative learning network of primary care practices and patient safety leaders to develop clear recommendations for handling ambulatory adverse events. The learning network developed recommendations on areas of ambulatory safety risk (test, referral, medication management, and communication issues), which resulted in decreased errors in demonstration sites.

With current AHRQ funding, Dr. Schiff’s research focuses on changing how prescriptions are written to include why the medication is being prescribed. His goal is to improve prescribing safety by redesigning computerized prescriber order entry to incorporate a medication indication into the prescription order. He believes that understanding the purpose of a medication is essential so that physicians, pharmacists, nurses, and patients are all aware of the condition being treated and the hoped-for outcomes.

Dr. Schiff is the author of numerous articles on patient safety issues and frequently shares the knowledge gained through his work with the field. He served as an invited expert and reviewer for the 2015 National Academy of Medicine report: Improving Diagnosis in Health Care. This report, funded in part by AHRQ, outlined the scope of the problem and presented conceptual models and recommendations for moving forward.

In 2016, Dr. Schiff spoke at AHRQ’s Diagnostic Safety Summit (PDF, 1.24 MB), providing physician and patient perspectives on the importance of improving diagnostic accuracy.

Principal Investigator: Gordon D. Schiff, M.D., Associate Director of Brigham and Women’s Center for Patient Safety Research and Practice and Associate Professor at Harvard Medical School, Boston.
Institution: Brigham and Women’s Hospital
Grantee Since: 2003
Type of Grant: Various

Consistent with its mission, AHRQ provides a broad range of extramural research grants and contracts, research training, conference grants, and intramural research activities. AHRQ is committed to fostering the next generation of health services researchers who can focus on some of the most important challenges facing our Nation's health care system.

To learn more about AHRQ's Research Education and Training Programs, please visit http://www.ahrq.gov/training.

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Page last reviewed June 2017
Page originally created June 2017