Missed and Delayed Adverse Events — The Cost of Fragmented Documentation

Introduction: Not All Safety Failures Are Errors

Some of the most consequential safety failures in oncology are not incorrect grades, but delayed recognition of adverse events. These delays often arise from fragmented documentation rather than poor clinical care.

Symptoms appear in one note, labs in another, and follow-up calls somewhere else entirely.

How Fragmentation Masks Signals

When information is scattered across encounters and systems, patterns are hard to see. A symptom noted casually over several visits may never trigger formal grading until it becomes severe.

By then, intervention opportunities may have passed.

The Impact on Patients and Trials

Delayed adverse event recognition affects patient outcomes and trial integrity. It can lead to avoidable hospitalizations, late dose adjustments, and retrospective data corrections.

These costs are rarely visible in dashboards, but they are real.

Using Automation to Surface Patterns

Automation can help by aggregating related signals across time and context. Repeated mentions, trends, and escalating frequency can be flagged for review.

Importantly, this does not require autonomy, only aggregation.

From Reactive to Proactive Safety

Reducing missed and delayed events shifts safety from reactive to proactive. When systems help humans see patterns earlier, clinical judgment can be applied when it matters most.