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Diagnostic Errors that Lead to Inappropriate Antimicrobial Use
We found previously that inappropriate inpatient antimicrobial use was often attributable to erroneous diagnoses. Here, we detail diagnostic errors and their relationship to inappropriate antimicrobial courses. Retrospective cohort study. Veterans Affairs hospital. A cohort of 500 randomly selected...
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| Published in: | Infection control and hospital epidemiology 2015-08, Vol.36 (8), p.949-956 |
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| container_title | Infection control and hospital epidemiology |
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| creator | Filice, Gregory A Drekonja, Dimitri M Thurn, Joseph R Hamann, Galen M Masoud, Bobbie T Johnson, James R |
| description | We found previously that inappropriate inpatient antimicrobial use was often attributable to erroneous diagnoses. Here, we detail diagnostic errors and their relationship to inappropriate antimicrobial courses.
Retrospective cohort study.
Veterans Affairs hospital.
A cohort of 500 randomly selected inpatients with an antimicrobial course.
Blinded reviewers judged the accuracy of the initial provider diagnosis for the condition that led to an antimicrobial course and whether the course was appropriate. RESULTS The diagnoses were correct in 291 cases (58%), incorrect in 156 cases (31%), and of indeterminate accuracy in 22 cases (4%). In the remaining 31 cases (6%), the diagnosis was a sign or symptom rather than a syndrome or disease. The odds ratio of a correct diagnosis was 4.3 (95% confidence interval [CI], 2.2-8.5) if the index condition was related to the reason for admission. When the diagnosis was correct, 181 of 292 courses (62%) were appropriate, compared with only 10 of 208 (5%) when the diagnosis was incorrect or indeterminate or when providers were treating a sign or symptom rather than a syndrome or disease (P |
| doi_str_mv | 10.1017/ice.2015.113 |
| format | article |
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Retrospective cohort study.
Veterans Affairs hospital.
A cohort of 500 randomly selected inpatients with an antimicrobial course.
Blinded reviewers judged the accuracy of the initial provider diagnosis for the condition that led to an antimicrobial course and whether the course was appropriate. RESULTS The diagnoses were correct in 291 cases (58%), incorrect in 156 cases (31%), and of indeterminate accuracy in 22 cases (4%). In the remaining 31 cases (6%), the diagnosis was a sign or symptom rather than a syndrome or disease. The odds ratio of a correct diagnosis was 4.3 (95% confidence interval [CI], 2.2-8.5) if the index condition was related to the reason for admission. When the diagnosis was correct, 181 of 292 courses (62%) were appropriate, compared with only 10 of 208 (5%) when the diagnosis was incorrect or indeterminate or when providers were treating a sign or symptom rather than a syndrome or disease (P<.001). Among the 309 cases in which antimicrobial courses were not appropriate, reasons varied by diagnostic accuracy; in 81 of 111 cases (73%) with a correct diagnosis, incorrect antimicrobial(s) were selected; in 166 of 198 other cases (84%), antimicrobial therapy was not indicated.
Diagnostic accuracy is important for optimal inpatient antimicrobial use. Antimicrobial stewardship strategies should help providers avoid diagnostic errors and know when antimicrobial therapy can be withheld safely.</description><identifier>ISSN: 0899-823X</identifier><identifier>EISSN: 1559-6834</identifier><identifier>DOI: 10.1017/ice.2015.113</identifier><identifier>PMID: 25998898</identifier><language>eng</language><publisher>United States: Cambridge University Press</publisher><subject>Accuracy ; Aged ; Anti-Bacterial Agents - therapeutic use ; Antimicrobial agents ; Bacterial Infections - diagnosis ; Bacterial Infections - drug therapy ; Cystitis - diagnosis ; Cystitis - microbiology ; Diagnostic Errors ; Electronic health records ; Female ; Hospitals ; Humans ; Hypotheses ; Inappropriate Prescribing ; Infectious diseases ; Male ; Medical Audit ; Medical diagnosis ; Medical errors ; Medical records ; Middle Aged ; Nursing ; Pneumonia - diagnosis ; Pneumonia - microbiology ; Pyelonephritis - diagnosis ; Pyelonephritis - microbiology ; Random Allocation ; Retrospective Studies ; Single-Blind Method</subject><ispartof>Infection control and hospital epidemiology, 2015-08, Vol.36 (8), p.949-956</ispartof><rights>2015 by The Society for Healthcare Epidemiology of America. All rights reserved</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c389t-359326ec1b302b112d3d5f0a12045eb3466b06a201b785c352b4bf6851aa1e483</citedby><cites>FETCH-LOGICAL-c389t-359326ec1b302b112d3d5f0a12045eb3466b06a201b785c352b4bf6851aa1e483</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25998898$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Filice, Gregory A</creatorcontrib><creatorcontrib>Drekonja, Dimitri M</creatorcontrib><creatorcontrib>Thurn, Joseph R</creatorcontrib><creatorcontrib>Hamann, Galen M</creatorcontrib><creatorcontrib>Masoud, Bobbie T</creatorcontrib><creatorcontrib>Johnson, James R</creatorcontrib><title>Diagnostic Errors that Lead to Inappropriate Antimicrobial Use</title><title>Infection control and hospital epidemiology</title><addtitle>Infect Control Hosp Epidemiol</addtitle><description>We found previously that inappropriate inpatient antimicrobial use was often attributable to erroneous diagnoses. Here, we detail diagnostic errors and their relationship to inappropriate antimicrobial courses.
Retrospective cohort study.
Veterans Affairs hospital.
A cohort of 500 randomly selected inpatients with an antimicrobial course.
Blinded reviewers judged the accuracy of the initial provider diagnosis for the condition that led to an antimicrobial course and whether the course was appropriate. RESULTS The diagnoses were correct in 291 cases (58%), incorrect in 156 cases (31%), and of indeterminate accuracy in 22 cases (4%). In the remaining 31 cases (6%), the diagnosis was a sign or symptom rather than a syndrome or disease. The odds ratio of a correct diagnosis was 4.3 (95% confidence interval [CI], 2.2-8.5) if the index condition was related to the reason for admission. When the diagnosis was correct, 181 of 292 courses (62%) were appropriate, compared with only 10 of 208 (5%) when the diagnosis was incorrect or indeterminate or when providers were treating a sign or symptom rather than a syndrome or disease (P<.001). Among the 309 cases in which antimicrobial courses were not appropriate, reasons varied by diagnostic accuracy; in 81 of 111 cases (73%) with a correct diagnosis, incorrect antimicrobial(s) were selected; in 166 of 198 other cases (84%), antimicrobial therapy was not indicated.
Diagnostic accuracy is important for optimal inpatient antimicrobial use. Antimicrobial stewardship strategies should help providers avoid diagnostic errors and know when antimicrobial therapy can be withheld safely.</description><subject>Accuracy</subject><subject>Aged</subject><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>Antimicrobial agents</subject><subject>Bacterial Infections - diagnosis</subject><subject>Bacterial Infections - drug therapy</subject><subject>Cystitis - diagnosis</subject><subject>Cystitis - microbiology</subject><subject>Diagnostic Errors</subject><subject>Electronic health records</subject><subject>Female</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Hypotheses</subject><subject>Inappropriate Prescribing</subject><subject>Infectious diseases</subject><subject>Male</subject><subject>Medical Audit</subject><subject>Medical diagnosis</subject><subject>Medical errors</subject><subject>Medical records</subject><subject>Middle Aged</subject><subject>Nursing</subject><subject>Pneumonia - diagnosis</subject><subject>Pneumonia - microbiology</subject><subject>Pyelonephritis - diagnosis</subject><subject>Pyelonephritis - microbiology</subject><subject>Random Allocation</subject><subject>Retrospective Studies</subject><subject>Single-Blind Method</subject><issn>0899-823X</issn><issn>1559-6834</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><recordid>eNpdkL9LAzEcxYMotlY3ZzlwcfBqvsklTRah1KqFgosFt5Dc5TTlftQkN_jfm2J1cHrLh8d7H4QuAU8Bw-zOlXZKMLApAD1CY2BM5lzQ4hiNsZAyF4S-jdBZCFuM8UxKOEUjwqQUQooxun9w-r3rQ3RltvS-9yGLHzpma6urLPbZqtO7ne933ulos3kXXetK3xunm2wT7Dk6qXUT7MUhJ2jzuHxdPOfrl6fVYr7OSypkzCmTlHBbgqGYGABS0YrVWAPBBbOGFpwbzHW6YWaClZQRU5iaCwZagy0EnaCbn9605XOwIarWhdI2je5sPwQFXHKQbEZIQq__odt-8F1ap4jAnEFRkH3h7Q-VzoTgba3SxVb7LwVY7b2q5FXtvarkNeFXh9LBtLb6g39F0m8LDnED</recordid><startdate>20150801</startdate><enddate>20150801</enddate><creator>Filice, Gregory A</creator><creator>Drekonja, Dimitri M</creator><creator>Thurn, Joseph R</creator><creator>Hamann, Galen M</creator><creator>Masoud, Bobbie T</creator><creator>Johnson, James R</creator><general>Cambridge University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88C</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>S0X</scope><scope>7X8</scope></search><sort><creationdate>20150801</creationdate><title>Diagnostic Errors that Lead to Inappropriate Antimicrobial Use</title><author>Filice, Gregory A ; Drekonja, Dimitri M ; Thurn, Joseph R ; Hamann, Galen M ; Masoud, Bobbie T ; Johnson, James R</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c389t-359326ec1b302b112d3d5f0a12045eb3466b06a201b785c352b4bf6851aa1e483</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Accuracy</topic><topic>Aged</topic><topic>Anti-Bacterial Agents - therapeutic use</topic><topic>Antimicrobial agents</topic><topic>Bacterial Infections - diagnosis</topic><topic>Bacterial Infections - drug therapy</topic><topic>Cystitis - diagnosis</topic><topic>Cystitis - microbiology</topic><topic>Diagnostic Errors</topic><topic>Electronic health records</topic><topic>Female</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Hypotheses</topic><topic>Inappropriate Prescribing</topic><topic>Infectious diseases</topic><topic>Male</topic><topic>Medical Audit</topic><topic>Medical diagnosis</topic><topic>Medical errors</topic><topic>Medical records</topic><topic>Middle Aged</topic><topic>Nursing</topic><topic>Pneumonia - diagnosis</topic><topic>Pneumonia - microbiology</topic><topic>Pyelonephritis - diagnosis</topic><topic>Pyelonephritis - microbiology</topic><topic>Random Allocation</topic><topic>Retrospective Studies</topic><topic>Single-Blind Method</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Filice, Gregory A</creatorcontrib><creatorcontrib>Drekonja, Dimitri M</creatorcontrib><creatorcontrib>Thurn, Joseph R</creatorcontrib><creatorcontrib>Hamann, Galen M</creatorcontrib><creatorcontrib>Masoud, Bobbie T</creatorcontrib><creatorcontrib>Johnson, James R</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Proquest Nursing & Allied Health Source</collection><collection>ProQuest Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Healthcare Administration Database (Alumni)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database (Proquest)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest One Sustainability</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>ProQuest Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>ProQuest Healthcare Administration Database</collection><collection>PML(ProQuest Medical Library)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>SIRS Editorial</collection><collection>MEDLINE - Academic</collection><jtitle>Infection control and hospital epidemiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Filice, Gregory A</au><au>Drekonja, Dimitri M</au><au>Thurn, Joseph R</au><au>Hamann, Galen M</au><au>Masoud, Bobbie T</au><au>Johnson, James R</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Diagnostic Errors that Lead to Inappropriate Antimicrobial Use</atitle><jtitle>Infection control and hospital epidemiology</jtitle><addtitle>Infect Control Hosp Epidemiol</addtitle><date>2015-08-01</date><risdate>2015</risdate><volume>36</volume><issue>8</issue><spage>949</spage><epage>956</epage><pages>949-956</pages><issn>0899-823X</issn><eissn>1559-6834</eissn><abstract>We found previously that inappropriate inpatient antimicrobial use was often attributable to erroneous diagnoses. Here, we detail diagnostic errors and their relationship to inappropriate antimicrobial courses.
Retrospective cohort study.
Veterans Affairs hospital.
A cohort of 500 randomly selected inpatients with an antimicrobial course.
Blinded reviewers judged the accuracy of the initial provider diagnosis for the condition that led to an antimicrobial course and whether the course was appropriate. RESULTS The diagnoses were correct in 291 cases (58%), incorrect in 156 cases (31%), and of indeterminate accuracy in 22 cases (4%). In the remaining 31 cases (6%), the diagnosis was a sign or symptom rather than a syndrome or disease. The odds ratio of a correct diagnosis was 4.3 (95% confidence interval [CI], 2.2-8.5) if the index condition was related to the reason for admission. When the diagnosis was correct, 181 of 292 courses (62%) were appropriate, compared with only 10 of 208 (5%) when the diagnosis was incorrect or indeterminate or when providers were treating a sign or symptom rather than a syndrome or disease (P<.001). Among the 309 cases in which antimicrobial courses were not appropriate, reasons varied by diagnostic accuracy; in 81 of 111 cases (73%) with a correct diagnosis, incorrect antimicrobial(s) were selected; in 166 of 198 other cases (84%), antimicrobial therapy was not indicated.
Diagnostic accuracy is important for optimal inpatient antimicrobial use. Antimicrobial stewardship strategies should help providers avoid diagnostic errors and know when antimicrobial therapy can be withheld safely.</abstract><cop>United States</cop><pub>Cambridge University Press</pub><pmid>25998898</pmid><doi>10.1017/ice.2015.113</doi><tpages>8</tpages></addata></record> |
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| identifier | ISSN: 0899-823X |
| ispartof | Infection control and hospital epidemiology, 2015-08, Vol.36 (8), p.949-956 |
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| language | eng |
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| source | Cambridge University Press |
| subjects | Accuracy Aged Anti-Bacterial Agents - therapeutic use Antimicrobial agents Bacterial Infections - diagnosis Bacterial Infections - drug therapy Cystitis - diagnosis Cystitis - microbiology Diagnostic Errors Electronic health records Female Hospitals Humans Hypotheses Inappropriate Prescribing Infectious diseases Male Medical Audit Medical diagnosis Medical errors Medical records Middle Aged Nursing Pneumonia - diagnosis Pneumonia - microbiology Pyelonephritis - diagnosis Pyelonephritis - microbiology Random Allocation Retrospective Studies Single-Blind Method |
| title | Diagnostic Errors that Lead to Inappropriate Antimicrobial Use |
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