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Missed and delayed diagnoses in the emergency department: a study of closed malpractice claims from 4 liability insurers.
Ann Emerg Med. 2007 Feb; 49(2):196-205.AE

Abstract

STUDY OBJECTIVES

Diagnostic errors in the emergency department (ED) are an important patient safety concern, but little is known about their cause. We identify types and causes of missed or delayed diagnoses in the ED.

METHODS

This is a review of 122 closed malpractice claims from 4 liability insurers in which patients had alleged a missed or delayed diagnosis in the ED. Trained physician reviewers examined the litigation files and the associated medical records to determine whether an adverse outcome because of a missed diagnosis had occurred, what breakdowns were involved in the missed diagnosis, and what factors contributed to it. Main outcome measures were missed diagnoses, process breakdowns, and contributing factors.

RESULTS

A total of 79 claims (65%) involved missed ED diagnoses that harmed patients. Forty-eight percent of these missed diagnoses were associated with serious harm, and 39% resulted in death. The leading breakdowns in the diagnostic process were failure to order an appropriate diagnostic test (58% of errors), failure to perform an adequate medical history or physical examination (42%), incorrect interpretation of a diagnostic test (37%), and failure to order an appropriate consultation (33%). The leading contributing factors to the missed diagnoses were cognitive factors (96%), patient-related factors (34%), lack of appropriate supervision (30%), inadequate handoffs (24%), and excessive workload (23%). The median numbers of process breakdowns and contributing factors per missed diagnosis were 2 and 3, respectively.

CONCLUSION

Missed diagnoses in the ED have a complex cause. They are typically the result of multiple breakdowns in the diagnostic process and several contributing factors.

Authors+Show Affiliations

Division of General Medicine, Brigham and Women's Hospital, Boston, MA, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

16997424

Citation

Kachalia, Allen, et al. "Missed and Delayed Diagnoses in the Emergency Department: a Study of Closed Malpractice Claims From 4 Liability Insurers." Annals of Emergency Medicine, vol. 49, no. 2, 2007, pp. 196-205.
Kachalia A, Gandhi TK, Puopolo AL, et al. Missed and delayed diagnoses in the emergency department: a study of closed malpractice claims from 4 liability insurers. Ann Emerg Med. 2007;49(2):196-205.
Kachalia, A., Gandhi, T. K., Puopolo, A. L., Yoon, C., Thomas, E. J., Griffey, R., Brennan, T. A., & Studdert, D. M. (2007). Missed and delayed diagnoses in the emergency department: a study of closed malpractice claims from 4 liability insurers. Annals of Emergency Medicine, 49(2), 196-205.
Kachalia A, et al. Missed and Delayed Diagnoses in the Emergency Department: a Study of Closed Malpractice Claims From 4 Liability Insurers. Ann Emerg Med. 2007;49(2):196-205. PubMed PMID: 16997424.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Missed and delayed diagnoses in the emergency department: a study of closed malpractice claims from 4 liability insurers. AU - Kachalia,Allen, AU - Gandhi,Tejal K, AU - Puopolo,Ann Louise, AU - Yoon,Catherine, AU - Thomas,Eric J, AU - Griffey,Richard, AU - Brennan,Troyen A, AU - Studdert,David M, Y1 - 2006/09/25/ PY - 2005/11/13/received PY - 2006/06/07/revised PY - 2006/06/26/accepted PY - 2006/9/26/pubmed PY - 2007/2/3/medline PY - 2006/9/26/entrez SP - 196 EP - 205 JF - Annals of emergency medicine JO - Ann Emerg Med VL - 49 IS - 2 N2 - STUDY OBJECTIVES: Diagnostic errors in the emergency department (ED) are an important patient safety concern, but little is known about their cause. We identify types and causes of missed or delayed diagnoses in the ED. METHODS: This is a review of 122 closed malpractice claims from 4 liability insurers in which patients had alleged a missed or delayed diagnosis in the ED. Trained physician reviewers examined the litigation files and the associated medical records to determine whether an adverse outcome because of a missed diagnosis had occurred, what breakdowns were involved in the missed diagnosis, and what factors contributed to it. Main outcome measures were missed diagnoses, process breakdowns, and contributing factors. RESULTS: A total of 79 claims (65%) involved missed ED diagnoses that harmed patients. Forty-eight percent of these missed diagnoses were associated with serious harm, and 39% resulted in death. The leading breakdowns in the diagnostic process were failure to order an appropriate diagnostic test (58% of errors), failure to perform an adequate medical history or physical examination (42%), incorrect interpretation of a diagnostic test (37%), and failure to order an appropriate consultation (33%). The leading contributing factors to the missed diagnoses were cognitive factors (96%), patient-related factors (34%), lack of appropriate supervision (30%), inadequate handoffs (24%), and excessive workload (23%). The median numbers of process breakdowns and contributing factors per missed diagnosis were 2 and 3, respectively. CONCLUSION: Missed diagnoses in the ED have a complex cause. They are typically the result of multiple breakdowns in the diagnostic process and several contributing factors. SN - 1097-6760 UR - https://www.unboundmedicine.com/medline/citation/16997424/Missed_and_delayed_diagnoses_in_the_emergency_department:_a_study_of_closed_malpractice_claims_from_4_liability_insurers_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0196-0644(06)00938-3 DB - PRIME DP - Unbound Medicine ER -