The investigation revealed that most VTE cases were diagnosed after more than 24 hours, and in many instances, delays extended beyond 72 hours. These diagnostic lapses were strongly tied to higher 30-day mortality, particularly when pulmonary embolism was missed. The findings highlight the urgent need for improved detection strategies to enhance patient safety.
The research was led by Min-Jeoung Kang from the Department of Medicine, Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, along with colleagues from Penn State Health. The team analyzed data from 3,525 patients across two major U.S. healthcare systems: Mass General Brigham (MGB) and Penn State Health (PSH). The study evaluated the use of the Delayed Diagnosis of VTE electronic clinical quality measure (DOVE eCQM), an automated tool designed to quantify diagnostic delays and assess their impact on patient outcomes.
For this purpose, retrospective data from electronic health records (EHRs) were assessed, covering 2016–2021 at MGB and 2019–2022 at PSH. The researchers categorized delays using thresholds of more than 24 hours and more than 72 hours. They also investigated the causes of missed opportunities, classifying them as practitioner-, system-, patient-, or other-related factors. Mortality risks were then compared between patients diagnosed promptly (within 24 hours) and those diagnosed late.
The study revealed the following notable findings:
- Diagnostic delays were common, with 79.4% of patients at MGB and 82.4% at PSH receiving a VTE diagnosis after 24 hours.
- Delays exceeding 72 hours occurred in approximately 70% of cases at both centers.
- Practitioner-related factors were responsible for most missed diagnoses.
- At MGB, 30-day all-cause mortality rose from 2.5% for timely diagnoses to 8.3% for delayed diagnoses (RR 3.31).
- At PSH, 30-day mortality increased from 4.6% to 5.9% with delayed diagnosis (RR 1.28).
- Many deaths occurring within the first 24 hours were associated with missed pulmonary embolism.
The authors emphasized that the nonspecific symptoms of VTE often hinder timely recognition, which underscores the importance of using systematic tools like the DOVE eCQM. This platform, validated across two different EHR systems, proved effective in quantifying delays and identifying their consequences. By enabling continuous monitoring, it could guide quality improvement initiatives at institutional, regional, and even national levels.
While the study demonstrated the potential of DOVE eCQM, the authors noted that some healthcare systems may face challenges in adopting natural language processing–based platforms. Even so, they argued that such digital solutions are critical to reducing diagnostic delays and improving outcomes in outpatient and primary care settings. Future work, they added, will focus on expanding DOVE eCQM to urgent care and emergency departments, as well as developing clinical decision support systems to help clinicians recognize VTE earlier.
"Overall, the study highlights that delayed recognition of VTE is common and deadly. By leveraging electronic tools such as DOVE eCQM, healthcare systems may be better equipped to reduce missed diagnoses, improve the timeliness of care, and ultimately save lives," the authors concluded.
Reference:
Kang M, Schreiber R, Baris VK, et al. Delayed Venous Thromboembolism Diagnosis and Mortality Risk. JAMA Netw Open. 2025;8(9):e2533928. doi:10.1001/jamanetworkopen.2025.33928
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