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Misdiagnosis in Emergency Departments to blame for 2.5 million harms

Misdiagnosis in Emergency Departments to blame for 2.5 million harms

According to a recent review of Emergency Department errors commissioned by the US Agency for Healthcare Research and Quality, diagnosis errors and misdiagnosis-related injuries could be to blame for more than 7 million errors, 2.5 million harms, and 350,000 patients suffering potentially preventable permanent disability or death. A key finding from the study was that just 15 clinical conditions accounted for the majority (68%) of diagnosis errors associated with high severity of harms. These conditions include vascular events such as strokes, infections, and cancer.

 An emergency medicine physician and a critical care physician who is now a Chief Quality Officer for a major hospital system offered the following takeaways from the study in an article published in the Journal of the American Medical Association (JAMA):

  1. Diagnostic errors are universal and occur in all specialties and areas of healthcare. The study notes that diagnostic error rates estimated in the ED are similar to error rates in other areas of medicine. The report estimates ED diagnostic error rate of 5.7%. Other studies have found a 6.3% error rate with primary care and 8% based on hospital autopsies. The authors note that in emergency medicine, the goal is not always to make a specific diagnosis, but to make a safe disposition where time-dependent conditions are treated, some patients are admitted for further evaluation and others are discharged for outpatient care.
  2. Diagnostic errors are largely invisible and greater transparency is needed. Data on diagnostic errors are messy and health care professionals have not yet adopted routine use of valid and practical ways to monitor diagnostic errors.
  3. The medical profession needs to take a systems approach to reduce diagnostic errors. The healthcare profession has relied on the heroism of individual clinicals rather than the design of safe systems to prevent diagnostic errors. Given the cognitive burden or remembering the typical and atypical presentations of thousands of diseases and extreme time pressures, the healthcare system is “perfectly designed” to produce the sorts of significant harm to which the report calls attention.

According to the authors, the healthcare profession needs to accept that physicians, being humans are fallible and systems of care to reduce diagnostic errors must be designed. The healthcare system needs to make efforts to re-design systems of care to prevent harm from other conditions. “To err may be human, but that does not mean that all medical errors have human causes or that we should accept diagnostic errors as an inevitable cost of doing business.”

Source: Edlow, J. and Pronovost, P. Misdiagnosis in the Emergency Department Time for a System Solution. JAMA. Published online January 27, 2023. doi:10.1001/jama.2023.0577.

Read the full article here.


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