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

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

doi:10.1186/s12873-019-0289-3

Abstract

BackgroundDiagnostic 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.MethodsA 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.ResultsThere 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.ConclusionsSystems 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.

Highlights

Diagnostic error occurs more frequently in the emergency department than in regular in-patient hospital care
Diagnostic error occurs more frequently in emergency departments than in the recorded 10–15% of adverse medical events for routine hospital in-patient hospital care [1]. These errors often result in serious patient harm [2, 3], and in the United States of America (USA) these errors are associated with a significant number of deaths per year [4]
Incidents are usually reported voluntarily by healthcare professionals, mainly doctors and nurses, who were involved with the incident and are done anonymously via an electronic platform (“Datix”), with most incidents being reported by acute trusts

Summary

Introduction

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. Diagnostic error occurs more frequently in emergency departments than in the recorded 10–15% of adverse medical events for routine hospital in-patient hospital care [1]. These errors often result in serious patient harm [2, 3], and in the United States of America (USA) these errors are associated with a significant number of deaths per year [4]. There is an opportunity to study diagnostic error in patient safety incident reports in parts of the UK as they comprise

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