Using voluntary reports from physicians to learn from diagnostic errors in emergency medicine

Area of Science:

• Medical Error Research
• Patient Safety in Emergency Medicine
• Diagnostic Accuracy Studies

Background:

• Diagnostic errors are a significant concern in emergency departments (EDs).
• Limited comprehensive studies exist on the types and origins of ED diagnostic errors.
• Understanding these errors is crucial for enhancing patient care and safety.

Purpose of the Study:

• To analyze incidents reported by ED physicians to identify disease conditions, contributing factors, and patient harm related to diagnostic errors.
• To provide a detailed breakdown of the origins and types of diagnostic errors in the ED setting.

Main Methods:

• Analysis of 209 diagnostic-related incidents reported by ED physicians between March 2009 and December 2013.
• Utilized a voluntary incident-reporting system implemented in two academic hospital-affiliated EDs.
• A quality assurance team reviewed incidents, interviewed physicians, and categorized errors, contributing factors, and patient harm.

Main Results:

• 214 diagnostic errors were identified across 65 diseases, with sepsis, acute coronary syndrome, fractures, and vascular injuries being most common.
• Key contributory factors included cognitive issues (e.g., faulty verification/processing) and system-related factors (e.g., high workload, inefficient processes).
• Major harm was associated with 16.3% of reported incidents, with most errors involving multiple contributing factors.

Conclusions:

• Diagnostic errors in the ED frequently involve common medical conditions.
• Sustaining diagnostic error reporting programs is vital for identifying specific targets to improve patient safety.
• The study underscores the value of incident reporting systems in understanding and mitigating ED diagnostic errors.