Diagnostic Delays for Infectious Diseases

Diagnostic delays are a critical but poorly understood type of diagnostic error [Institute of Medicine 2015, Arch Intern Med 2009]. Diagnostic delays are particularly important when the infection is communicable and can increase the risk of additional exposures and more cases.

The goal of this query is to better understand the relative frequency of diagnostic delays for infectious diseases and potential risk factors for these delays.
DEFINITIONS Diagnostic delay = a case where sufficient data were available to make the correct diagnosis at an earlier point in the course of a patient’s illness.

For each Question #1	For each Question #3
Rarely = 1 or 2 cases ever	No impact = no effect at all
Infrequently = 1 case every few years	Minor impact = patient dissatisfaction or minor delay
Occasionally = a few cases each year	Moderate impact = prolonged hospitalization/short-term morbidity
Commonly = several cases each month	Major impact = permanent disability/life-threatening event

Name:                                                     EIN ID: If you see too few cases of diagnostic delays to respond, please check here and submit the survey. A. TUBERCULOSIS        I do not see enough to answer [skip to section B] When treating this condition, how often do you observe diagnostic delays? Rarely       Infrequently       Occasionally       Commonly Are you typically consulted:    Too early       At the right time       Too late When you are consulted too late, the delay typically results in: No impact       Minor impact       Moderate impact       Major impact       The most common contributor to the diagnostic delay I observe is: [pull down for options] The diagnosis was not considered initially Specific tests (e.g. cultures, serologies) were not ordered Missing data (e.g. travel history, immune status) Unusual clinical presentation None of the above B. NONTUBERCULOUS MYCOBACTERIAL INFECTIONS I do not see enough to answer [skip to section C] When treating this condition, how often do you observe diagnostic delays? Rarely       Infrequently       Occasionally       Commonly Are you typically consulted:    Too early       At the right time       Too late When you are consulted too late, the delay typically results in: No impact       Minor impact       Moderate impact       Major impact       The most common contributor to the diagnostic delay I observe is: [pull down for options] The diagnosis was not considered initially Specific tests (e.g. cultures, serologies) were not ordered Missing data (e.g. travel history, immune status) Unusual clinical presentation None of the above C. SYPHILIS I do not see enough to answer [skip to section D] When treating this condition, how often do you observe diagnostic delays? Rarely       Infrequently       Occasionally       Commonly Are you typically consulted:    Too early       At the right time       Too late When you are consulted too late, the delay typically results in: No impact       Minor impact       Moderate impact       Major impact       The most common contributor to the diagnostic delay I observe is: [pull down for options] The diagnosis was not considered initially Specific tests (e.g. cultures, serologies) were not ordered Missing data (e.g. travel history, immune status) Unusual clinical presentation None of the above D. EPIDURAL ABSCESS        I do not see enough to answer [skip to section E] When treating this condition, how often do you observe diagnostic delays? Rarely       Infrequently       Occasionally       Commonly Are you typically consulted:    Too early       At the right time       Too late When you are consulted too late, the delay typically results in: No impact       Minor impact       Moderate impact       Major impact       The most common contributor to the diagnostic delay I observe is: [pull down for options] The diagnosis was not considered initially Specific tests (e.g. cultures, serologies) were not ordered Missing data (e.g. travel history, immune status) Unusual clinical presentation None of the above E. INFECTIVE ENDOCARDITIS        I do not see enough to answer [skip to section F] When treating this condition, how often do you observe diagnostic delays? Rarely       Infrequently       Occasionally       Commonly Are you typically consulted:    Too early       At the right time       Too late When you are consulted too late, the delay typically results in: No impact       Minor impact       Moderate impact       Major impact       The most common contributor to the diagnostic delay I observe is: [pull down for options] The diagnosis was not considered initially Specific tests (e.g. cultures, serologies) were not ordered Missing data (e.g. travel history, immune status) Unusual clinical presentation None of the above F. ENDEMIC FUNGAL INFECTIONS (e.g. histoplasmosis, blastomycosis) I do not see enough to answer [submit survey] When treating this condition, how often do you observe diagnostic delays? Rarely       Infrequently       Occasionally       Commonly Are you typically consulted:    Too early       At the right time       Too late When you are consulted too late, the delay typically results in: No impact       Minor impact       Moderate impact       Major impact       The most common contributor to the diagnostic delay I observe is: [pull down for options] The diagnosis was not considered initially Specific tests (e.g. cultures, serologies) were not ordered Missing data (e.g. travel history, immune status) Unusual clinical presentation None of the above      What diagnostic delays do you see most frequently in your practice?