Diagnostic error in the emergency department: learning from national patient safety incident report analysis

Author:

Hussain Faris,Cooper AlisonORCID,Carson-Stevens Andrew,Donaldson Liam,Hibbert Peter,Hughes Thomas,Edwards Adrian

Abstract

Abstract Background Diagnostic error occurs more frequently in the emergency department than in regular in-patient hospital care. We sought to characterise the nature of reported diagnostic error in hospital emergency departments in England and Wales from 2013 to 2015 and to identify the priority areas for intervention to reduce their occurrence. Methods A cross-sectional mixed-methods design using an exploratory descriptive analysis and thematic analysis of patient safety incident reports. Primary data were extracted from a national database of patient safety incidents. Reports were filtered for emergency department settings, diagnostic error (as classified by the reporter), from 2013 to 2015. These were analysed for the chain of events, contributory factors and harm outcomes. Results There were 2288 cases of confirmed diagnostic error: 1973 (86%) delayed and 315 (14%) wrong diagnoses. One in seven incidents were reported to have severe harm or death. Fractures were the most common condition (44%), with cervical-spine and neck of femur the most frequent types. Other common conditions included myocardial infarctions (7%) and intracranial bleeds (6%). Incidents involving both delayed and wrong diagnoses were associated with insufficient assessment, misinterpretation of diagnostic investigations and failure to order investigations. Contributory factors were predominantly human factors, including staff mistakes, healthcare professionals’ inadequate skillset or knowledge and not following protocols. Conclusions Systems modifications are needed that provide clinicians with better support in performing patient assessment and investigation interpretation. Interventions to reduce diagnostic error need to be evaluated in the emergency department setting, and could include standardised checklists, structured reporting and technological investigation improvements.

Publisher

Springer Science and Business Media LLC

Subject

Emergency Medicine

Reference77 articles.

1. Berner ES, Graber ML. Overconfidence as a cause of diagnostic error in medicine. Am J Med. 2008;121(5 Suppl):S2–23. https://doi.org/10.1016/j.amjmed.2008.01.001.

2. Brennan TA, Leape LL, Laird NM, Hebert L, Localio AR, Lawthers AG, et al. Incidence of adverse events and negligence in hospitalized patients. Results of the Harvard Medical Practice Study I. New Engl J Med. 1991;324(6):370–6. https://doi.org/10.1056/NEJM199102073240604.

3. The College of Emergency Medicine Acute and Emergency Care: prescribing the remedy. 2014 The College of Emergency Medicine; 2017.

4. Society to Improve Diagnosis in Medicine. About diagnostic error. The Institute of Medicine Website: Society to Improve Diagnosis in Medicine; 2017 (Accessed 13/10/2017). Available from: http://www.improvediagnosis.org/page/AboutDiagnosticErr

5. Anandaciva S. A&E performance reaches new low. London: The King's Fund; 2018 (Accessed 20/04/2018). Available from: https://http://www.kingsfund.org.uk/blog/2018/01/ae-performance-reaches-new-low.

Cited by 45 articles. 订阅此论文施引文献 订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3