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Perspectivas

Pasar por alto los errores de diagnóstico: las graves consecuencias potenciales para la seguridad del paciente

Por qué es importante

"Según los análisis realizados por la Sociedad Danesa para la Seguridad del Paciente, los errores de diagnóstico no sólo son comunes, sino que también tienen importantes consecuencias para los pacientes y las finanzas del sistema sanitario".

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Overlooking Diagnostic Errors The Grave Potential Consequences for Patient Safety

Foto de Dmitriy Gutarev | Pixabay

A nivel internacional, existe una creciente conciencia sobre los errores de diagnóstico como un problema importante (y con demasiada frecuencia pasado por alto) de seguridad del paciente. Según los análisis realizados por la Sociedad Danesa para la Seguridad del Paciente, los errores de diagnóstico no sólo son comunes, sino que también tienen importantes consecuencias para los pacientes y las finanzas del sistema sanitario. Nuestra esperanza es que crear conciencia sobre el proceso de diagnóstico y las posibles vulnerabilidades pueda ayudar a mejorar la seguridad del paciente.

Primero definamos el alcance de nuestro análisis. Para comprender mejor el proceso y su potencial de daño, analizamos los diagnósticos a lo largo de todo el recorrido del paciente. El primer paso es conseguir acceso al sistema de atención sanitaria. La evaluación diagnóstica inicial luego incluye la historia del paciente, el examen físico, la evaluación de las principales quejas y síntomas del paciente, la formación de un diagnóstico diferencial y la solicitud de pruebas de diagnóstico. En la fase de prueba se realiza la realización de las pruebas, la interpretación de los resultados y la comunicación de los resultados de las pruebas. Cuando sea apropiado, luego hay seguimiento médico, derivaciones, consultas y otras comunicaciones entre profesionales de la salud, y el seguimiento posterior entre el paciente y el sistema de atención médica.

Para que los pacientes reciban el tratamiento y la atención adecuados en el sistema de atención sanitaria, un diagnóstico oportuno y correcto es un requisito previo. Un diagnóstico que se pasa por alto, se retrasa o es incorrecto puede tener graves consecuencias para los pacientes y sus familias. En el peor de los casos, esto puede incluir incapacidad para trabajar, discapacidad o muerte. Por lo tanto, mejorar la seguridad y confiabilidad del proceso de diagnóstico tiene grandes beneficios potenciales a nivel individual, social y económico.


Obtenga más información sobre la seguridad del paciente en el IHI Forum


En Dinamarca, en lugar de tener que acudir a los tribunales para obtener una indemnización por haber sufrido un daño en el sistema sanitario, los pacientes pueden solicitarla gratuitamente a una autoridad pública para recibir una indemnización. En 2019, la Sociedad Danesa para la Seguridad del Paciente y la Asociación Danesa de Compensación al Paciente (cuyo propósito es evaluar las reclamaciones de compensación de acuerdo con la Ley Danesa de Compensación al Paciente) publicaron el informe “Mejorando el diagnóstico en la atención sanitaria danesa”, que expuso la alta frecuencia de errores de diagnóstico. ocurriendo en Dinamarca. El informe encontró que en el período de 10 años entre 2009 y 2018, se habían pagado 2.250 millones de coronas danesas (aproximadamente 318 millones de dólares) en compensación a pacientes lesionados debido a errores de diagnóstico en el sistema de atención médica danés.

La población de Dinamarca es de aproximadamente 5,8 millones de personas. En este período de 10 años, la Asociación Danesa de Compensación de Pacientes ha resuelto un total de 13.000 casos relacionados con errores de diagnóstico, de los cuales 7.600 han sido reconocidos. Estos son casos graves. La muerte por error de diagnóstico es casi dos veces más común por error de diagnóstico que por otras lesiones de tratamiento reconocidas. Más del 8 por ciento de los casos reconocidos con errores de diagnóstico han tenido como resultado directo la muerte del paciente. Seleccionamos 213 casos para su posterior análisis. En el 80 por ciento de los casos analizados, se pudo encontrar un factor que contribuyó al error de diagnóstico durante la evaluación clínica inicial.

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escritura, la reserva, el número/el número/tal se genera automáticamente" v:shapes="Billede_x0020_1">

(Fuente: Sociedad Danesa para la Seguridad del Paciente) Se adaptó una herramienta de análisis cualitativo para identificar la fase del proceso de diagnóstico en la que se produjeron errores a partir de una del Informe de evaluación comparativa anual de CRICO de 2014: Riesgos de mala praxis en el proceso de diagnóstico .

Los datos de la Asociación Danesa de Compensación al Paciente no reflejan todos los errores de diagnóstico en Dinamarca, y es razonable suponer que los errores de diagnóstico no se denuncian porque no todas las personas con lesiones indemnizables presentan una reclamación. Los hallazgos del primer informe nos hicieron desear saber más. En junio de 2023 publicamos un nuevo análisis, esta vez de eventos adversos, para investigar si este tipo de casos pueden ayudar a identificar debilidades en el proceso de diagnóstico.

La Autoridad de Seguridad del Paciente de Dinamarca recopila anualmente más de 200.000 informes de incidentes relacionados con la seguridad del paciente por parte de trabajadores de la salud y pacientes a través de un sistema de notificación obligatorio y no punitivo. Los informes se registran en la Base de Datos de Seguridad del Paciente de Dinamarca. Sin embargo, la base de datos no indica si un evento adverso estaba relacionado con el diagnóstico. Cada caso fue evaluado para determinar si estaba relacionado con el proceso de diagnóstico.

Examinamos tres muestras diferentes de eventos adversos. Una muestra incluyó solo eventos graves y fatales y dos muestras incluyeron todos los grados de gravedad, desde ningún daño hasta leve, moderado, grave y fatal. Descubrimos que aproximadamente un tercio de todos los eventos graves y fatales informados estaban relacionados con el proceso de diagnóstico. Además, determinamos que hay al menos tantos eventos relacionados con el diagnóstico como relacionados con la medicación entre los eventos graves y fatales. Como descubrimos durante la investigación para nuestro primer informe, nuestro análisis indicó nuevamente que, en los eventos graves y fatales relacionados con el diagnóstico, a menudo se produjeron errores durante la evaluación clínica del paciente.

Cuando analizamos muestras con todos los grados de daño (incluidas muchas con daño leve o nulo), pudimos identificar otras debilidades en el proceso de diagnóstico. Muchos eventos, por ejemplo, estaban relacionados con la logística, la comunicación y la falta de seguimiento de los resultados de las pruebas y las derivaciones.

La Sociedad Danesa para la Seguridad del Paciente ha creado una red nacional para abordar el problema de los errores de diagnóstico y concienciar sobre esta importante cuestión de seguridad del paciente. No hay duda de que este asunto merece más atención y una recopilación más sistemática de datos en beneficio de los pacientes, sus familiares, los trabajadores de la salud y las finanzas del sistema de atención sanitaria.

Charlotte Frendved es asesora de comunicaciones de la Sociedad Danesa para la Seguridad del Paciente. Siri Tribler, MD, PhD, es consultora de la Sociedad Danesa para la Seguridad del Paciente.

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Resumen en inglés: Mejora del diagnóstico en la atención sanitaria danesa 2 (2023)

Resumen en inglés: Mejora de los diagnósticos en la atención sanitaria danesa (2019)

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