Diagnostic error in an ophthalmic emergency department

Area of Science:

• Ophthalmology
• Medical Diagnostics
• Healthcare Quality

Background:

• Diagnostic error is a significant cause of patient harm.
• Limited data exists on misdiagnosis rates within ophthalmic emergency departments (EDs).
• Misdiagnosis is defined as an initial diagnosis later proven incorrect.

Purpose of the Study:

• To determine the rates of misdiagnosis among healthcare providers referring to and working within an ophthalmic ED.
• To compare diagnostic error rates in an ophthalmic ED setting with general medical error rates.

Main Methods:

• A retrospective audit of ophthalmic presentations at the Royal Victorian Eye and Ear Hospital (RVEEH) ED.
• Data collected over a one-week period.
• Analysis of misdiagnosis rates for various referring groups and hospital doctors.

Main Results:

• 534 ophthalmic presentations were analyzed.
• Referrer misdiagnosis rates varied: general practitioners (30%), optometrists (25.5%), external EDs (18.8%), external ophthalmology (25%), private ophthalmologists (0%).
• RVEEH doctor misdiagnosis rates ranged from 0% (fourth-year registrars, fellows) to 16.7% (residents).

Conclusions:

• Misdiagnosis rates in this ophthalmic ED were comparable to general medical diagnostic error rates (10-15%).
• This pilot study suggests a need for larger, multi-center audits.
• Further research should focus on diagnostic error in ophthalmic care within general emergency departments.