Eight frequently misdiagnosed conditions can be rectified with good CDI, coding practices

By Brian Murphy

 

What conditions are most frequently misdiagnosed, leading to patient harm?

 

A study by the general internal medicine team at Brigham and Women’s Hospital and Harvard Medical School in Boston (yay, my backyard! No Harvard jokes please) found that 1 in 14 general medicine patients (7%) experience harm from diagnostic errors.

 

If you’re a CDI professional you probably won’t be too surprised by the list. They include:
 

• Heart failure
• Acute kidney injury
• Sepsis
• Pneumonia
• Respiratory failure
• Altered mental state
• Abdominal pain
• Hypoxemia

 

The study was a random sample of 675 hospital patients who received general medical care from July 2019 through September 2021, minus the peak of the COVID-19 pandemic to avoid skewing the data.

 

Diagnostic errors were identified in 160 instances in 154 patients, with harm from misdiagnosis affecting 82 patients.

 

18 of these cases (21%) were fatal.

 

Perhaps the most startling statistic? Up to 85% of these errors could be prevented.

 

Most studies of diagnostic error and patient harm are limited to the current admission. Authors of this study went beyond the admission period, following patients for 90 days post charge. That led to the larger estimated prevention number.

 

Of further interest, study authors stated that AI-based tools for medical record screening could reduce the risk of misdiagnosis. While I’m skeptical of AI it does paint a strong use case for technology that can summarize data quickly, retrieve it, and elevate to the provider’s attention.

 

We often talk about purpose in work. I’ve noticed some CDI and coding professionals get a bit squeamish when talking about the financial impact of their work. And that goes for some physicians too (“you’re just in it for the money!”)

 

First, let’s drop that shame. Hospitals need revenue to keep their doors open. Physicians want to get paid their professional fees, too.

 

Second, CDI and coding professionals are part of the chain of care, which includes accurate diagnosis.

 

If you are reviewing charts and issuing concurrent queries/clarifications, you are making a positive impact on patient care. Spotting a medication without an associated diagnosis, for example, or initiating a query for sepsis based on elevated white blood cell count and temperature that triggers early intervention and life-saving care.

 

If you educate MDs about common clinical indicators, the repetition may be the trigger a provider needs to render a correct diagnosis. You may wish to incorporate additional education on the diagnoses in this study (which will also help with your risk adjustment and indirect revenue).

 

Your work can help save a life. No joke.

 

No I’ll go PAHK MY CAH in HAHVAD YAHD.

 

(that is a joke, a terrible one, but very Boston)

 

What do you think of this study? I’d love to hear any examples of how your work has impacted patient care including diagnostic accuracy. Hit me up at brian.murphy@norwood.com.

 

References

 

• Becker’s, “Diagnostic Errors Affect 7% of Patients: 7 Notes”: https://www.beckersphysicianleadership.com/news/diagnostic-errors-affect-7-of-patients-7-notes.html

 

• Medscape, Hospital Diagnostic Errors May Affect 7% of Patients: https://www.medscape.com/viewarticle/hospital-diagnostic-errors-may-affect-7-patients-2024a1000jal