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72h returns: A trigger tool for diagnostic error.

Emily Aaronson1, Pierre Borczuk2, Theodore Benzer2

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This summary is machine-generated.

Reviewing emergency department (ED) returns within 72 hours has low yield for identifying suboptimal care. Most identified errors were diagnostic, often stemming from cognitive failures in the initial patient assessment.

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Area of Science:

  • Emergency Medicine
  • Quality Assurance
  • Patient Safety

Background:

  • Patients returning to the Emergency Department (ED) within 72 hours of discharge are frequently used for quality assurance.
  • However, the effectiveness and types of errors identified through these reviews are not well understood.

Purpose of the Study:

  • To determine the prevalence, types, and severity of errors in patients returning to the ED within 72 hours and requiring hospital admission.

Main Methods:

  • A retrospective review was conducted on patients presenting to an urban, university-affiliated ED between October 1, 2012, and September 30, 2015.
  • The study focused on patients who returned within 72 hours and were subsequently admitted to the hospital.

Main Results:

  • Out of 413,167 ED visits, 2001 (0.48%) patients returned within 72 hours and were admitted.
  • Deviations from optimal care were identified in 50 (2.49%) of these patients, with 48 (96%) attributed to diagnostic error.
  • Failures in the initial diagnostic pathway accounted for the majority (60.4%) of these errors, with 32% resulting in minor harm and 68% in major harm or death.

Conclusions:

  • Screening 72-hour ED returns has a low yield for detecting suboptimal care, with less than 3% of cases showing deviations.
  • The majority of identified errors are cognitive in nature, occurring during the diagnostic process.
  • While potentially useful for evaluating individual clinician performance, these reviews may have limited value in identifying systemic issues contributing to unsafe care.