Addressing the Persistent Risk of Missed and Delayed Diagnoses

Missed and delayed diagnoses remain among the most persistent and consequential challenges in the delivery of health care. Indeed, these cases are a leading contributor to malpractice claims that are more often associated with significant patient harm and high financial liability.

A Pervasive Patient Safety Concern

According to the national medical professional liability claims database, Candello, a division of CRICO, diagnostic errors account for approximately 20 percent of all cases asserted between 2015–2024 and carry losses and potential losses of approximately $5B. Furthermore, about 68 percent of these cases involved a high-severity injury or death (based on the National Association of Insurance Commissioners Severity Scale).

“High-risk clinical conditions such as cancer, cardiovascular events, and infections are particularly vulnerable to diagnostic delay. Yet even routine findings can escalate if abnormal results are not clearly documented, communicated, or acted upon. While clinical reasoning remains a cornerstone of effective diagnosis, clinicians must be supported by systems that ensure continuity, follow-up, and shared responsibility,” said Dr. Matthew Germak, VP of Patient Safety at CRICO.

Case in Point: Prostate Cancer

Although often slow-growing, a delayed diagnosis of prostate cancer can significantly affect treatment options and prognosis. A newly released online Continuing Medical Education activity, “Maximizing Optimal Practices to Decrease Malpractice Risks in Allegations of Delayed or Missed Prostate Cancer” describes common pitfalls leading to allegations of delayed diagnosis of prostate cancer. The course also provides strategies on how to strengthen practice and mitigate gaps identified in malpractice cases.

Enroll in the ~20 minute course

Broader Implications for Diagnostic Safety

The issues highlighted in the prostate cancer case are not unique to urology. Diagnosis errors also frequently arise in primary care and other ambulatory settings, where complex workflows, time constraints, and fragmented communication can impede timely and accurate diagnoses.

Closing the Loop with Ambulatory Safety Nets (ASNs)

One solution with demonstrated potential is the implementation of ASNs—a structured approach to identify and address gaps in follow-up care. ASNs proactively monitor for diagnostic process failures, such as unreviewed test results or missed referrals, and initiate outreach to re-engage patients before harm occurs.

ASNs shift the focus from reactive error recovery to proactive harm prevention. By embedding safety nets into routine practice, organizations can mitigate the risk of diagnostic errors while also strengthening trust, reducing liability, and improving outcomes. For example, Kaiser Permanente’s colorectal cancer ASN program “reduced cancer incidence by a third, halved deaths, and eliminated racial differences in outcomes.”

Other recommended strategies include:

• Clear, structured documentation to support clinical reasoning and accountability.
• Diagnostic “pause points” to reassess when patients fail to respond as expected.
• Clinical decision support tools to supplement clinical judgment.

Missed and delayed diagnoses are a complex challenge—one that demands equal attention to clinical reasoning and system design. While no intervention eliminates uncertainty, health care organizations can substantially reduce risk through targeted improvements in communication, workflow integration, and safety culture.