Exploration of clinically significant adverse events in adult non-traumatic emergency department discharged patients through the basic management process analysis - A five-year experience

Abstract

Relatively little is well known about the causes of emergency department (ED) adverse events/errors. The main purpose of this study was to explore clinically significant adverse events (CSAEs), with an emphasis on those related to physicians' factors, in discharged patients of emergency medicine (EM) through an analysis of the basic management process. We designed a retrospective study to determine CSAEs in the discharged patients of EM and explored these adverse events, based on the basic management process. The collected cases were those who returned to the ED within 3 days, after being discharged directly from the EM section (EMS), between February 1, 2002, and January 31, 2007. The basic management process includes history taking, physical examinations, laboratory/radiological examinations, and observation. Our main outcome measurements were the inadequacies, their related evidence, and their descriptive statistics (counts and proportions) in the basic management process in cases of CSAEs. Among the 101,402 patients discharged from the EMS, 1,230 [1.21%, 95% confidence interval (CI) = 1.03% – 1.39%] were determined to have CSAEs. Among these 1,230 cases, physicians' factors accounted for 722 (58.7%) and disease progress 508 (41.3%). The CSAEs rate related to physicians' factors was 0.7% (722/101,402, 95% CI = 0.69% – 0.75%). Regarding the causes of CSAEs related to physicians' factors (772), lack of observation was the most common (42.4%, 306/722), followed by the inadequacy in history taking (34.2%, 247/722). Only 8 (8/722, 1.1%) of the CSAEs were determined as being caused purely by “judgment defects”. In this study, we found that 41.8% of CSAEs were due to disease process and 58.2% related to physicians' factors in the discharged patients of EM. Among CSAEs related to physicians' factors, most were caused by inadequacies in basic management flow and only a small minority was purely the result of “judgment defects”. After reviewing the related evidence with regards to these CSAEs, clusters of common causes were noted.