ER Diagnosis Not Always Right Or Timely

There are definite breakdowns in the diagnostic process in emergency rooms that can cause serious injury and death. The National Library of Medicine has posted an abstract of a recent medical journal article detailing the nature of the breakdowns. The news is not good.

Missed and Delayed Diagnoses in the Emergency Department: A Study of Closed Malpractice Claims From 4 Liability Insurers. (Ann Emerg Med. 2006 Sep 22)

Diagnostic errors in the emergency department (ED) are an important patient safety concern, but little is known about their cause.

This is a review of 122 closed malpractice claims from 4 liability insurers in which patients had alleged a missed or delayed diagnosis in the ED. Trained physician reviewers examined the litigation files and the associated medical records to determine whether an adverse outcome because of a missed diagnosis had occurred, what breakdowns were involved in the missed diagnosis, and what factors contributed to it.

A total of 79 claims (65%) involved missed ED diagnoses that harmed patients. Forty-eight percent of these missed diagnoses were associated with serious harm, and 39% resulted in death.

The leading breakdowns in the diagnostic process were failure to order an appropriate diagnostic test (58% of errors), failure to perform an adequate medical history or physical examination (42%), incorrect interpretation of a diagnostic test (37%), and failure to order an appropriate consultation (33%).

The leading contributing factors to the missed diagnoses were cognitive factors (96%), patient-related factors (34%), lack of appropriate supervision (30%), inadequate handoffs (24%), and excessive workload (23%).

Perhaps the most frustrating contributing factor to me is inadequate handoffs. This occurs after the emergency room personnel have properly attended to the patient. Poor communications with the other medical providers in the hospital then cause the situation to deteriorate. One would think the handoff could be accomplished flawlessly.

There are definite breakdowns in the diagnostic process in emergency rooms that can cause serious injury and death. The National Library of Medicine has posted an abstract of a recent medical journal article detailing the nature of the breakdowns. The news is not good.

Missed and Delayed Diagnoses in the Emergency Department: A Study of Closed Malpractice Claims From 4 Liability Insurers. (Ann Emerg Med. 2006 Sep 22)

Diagnostic errors in the emergency department (ED) are an important patient safety concern, but little is known about their cause.

This is a review of 122 closed malpractice claims from 4 liability insurers in which patients had alleged a missed or delayed diagnosis in the ED. Trained physician reviewers examined the litigation files and the associated medical records to determine whether an adverse outcome because of a missed diagnosis had occurred, what breakdowns were involved in the missed diagnosis, and what factors contributed to it.

A total of 79 claims (65%) involved missed ED diagnoses that harmed patients. Forty-eight percent of these missed diagnoses were associated with serious harm, and 39% resulted in death.

The leading breakdowns in the diagnostic process were failure to order an appropriate diagnostic test (58% of errors), failure to perform an adequate medical history or physical examination (42%), incorrect interpretation of a diagnostic test (37%), and failure to order an appropriate consultation (33%).

The leading contributing factors to the missed diagnoses were cognitive factors (96%), patient-related factors (34%), lack of appropriate supervision (30%), inadequate handoffs (24%), and excessive workload (23%).

Perhaps the most frustrating contributing factor to me is inadequate handoffs. This occurs after the emergency room personnel have properly attended to the patient. Poor communications with the other medical providers in the hospital then cause the situation to deteriorate. One would think the handoff could be accomplished flawlessly.