Diagnosing pneumonia correctly

Professor Kumar Visvanathan (Department of Medicine, St Vincent's Hospital) received a grant from Avant Foundation in 2018 to study the implications of incorrect diagnosis of pneumonia in hospitals.

He presented his research and received the award at the Avant Foundation Grants and Scholarships Awards dinner in February this year.

His research, featured below, appeared in the Avant Mutual Connect magazine (Issue 12; May 2019).

Simple idea, significant implications

Professor Visvanathan noticed more patients were being incorrectly diagnosed than he expected during his months on service in infectious diseases.

"It struck me that an important cause of hospital error is diagnostic error," Professor Visvanathan said.

"Those who are incorrectly diagnosed with pneumonia may have a longer stay in hospital, higher readmission rates, greater exposure to antibiotics and, as a consequence, higher rates of C. difficile," he said.

This anecdotal experience was backed up by a literature review, which prompted Professor Visvanathan to undertake the study with a team of five researchers, each representing a link in the chain of pneumonia diagnosis.

"With digitisation we can now look back on hospital records efficiently, so we picked out all the diagnosed pneumonia cases over a two-year period and quantified diagnostic accuracy using medical records, focusing on symptoms, investigations and radiology," Professor Visvanathan said.

"We haven't finished our analysis yet but we're well on our way," he said.

"Looks to be about 30% of pneumonia diagnoses are incorrect."

"Now we have to look for interventions, because there is the opportunity to make a big difference."

Next steps

The results of the analysis will help inform the development of strategies to improve diagnostic accuracy.

"There are different ways you can go about this and it's tempting to address it with education," Professor Visvanathan said.

"But I don't think education per se is a problem," he said.

"I think it's more related to the pressure young doctors are under."

"Pilots go through a checklist to make sure everything's secure before they fly."

"In the same way, I think we can do up a checklist for diagnosing pneumonia so we know the diagnosis is more definitive."

Optimising communication and workforce culture may also be important to improve diagnosis.

"If we can improve diagnostic accuracy we can improve patient outcomes, as well as ensure resources are used more effectively," Professor Visvanathan said.

"By lowering the unnecessary use of broad spectrum antibiotics in our own context, we may see real and tangible clinical benefits in our patient population and the antimicrobial resistance profile of the hospital," he said.

"This initiative could effect real change and rapid improvement in a common area of diagnostic error."

"This will result in a reduction of risk for practitioners and have significant benefits for patients."