Adverse events among patients registered in high-acuity areas of the emergency department: a prospective cohort study

Calder, Lisa A.; Forster, Alan J.; Nelson, Melanie Dawn; Leclair, Jason; Perry, Jeffrey J.; Vaillancourt, Christian; Hebert, Guy; Cwinn, A. Adam; Wells, George; Stiell, Ian G.

doi:10.1017/s1481803500012574

Cited by 64 publications

(89 citation statements)

References 21 publications

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“…Data collected from such databases allow for the identification of patterns of medical errors and analyses of these data are important tools in studies on patient safety 16 17. Our CSAEs rate was 0.80% (165/20 512, 95% CI 0.75% to 0.95%), which was comparable with the rate of 0.71% in our previous report (54/7646, 95% CI 0.54% to 0.93%) 9.…”

Section: Discussionsupporting

confidence: 81%

Evaluation of clinically significant adverse events in patients discharged from a tertiary-care emergency department in Taiwan

et al. 2012

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ObjectiveTo investigate the reasons for the occurrence of clinically significant adverse events (CSAEs) in emergency department-discharged patients through emergency physicians' (EPs) subjective reasoning and senior EPs' objective evaluation.DesignThis was a combined prospective follow-up and retrospective review of cases of consecutive adult non-traumatic patients who presented to a tertiary-care emergency department in Taiwan between 1 September 2005 and 31 July 2006. Data were extracted from ‘on-duty EPs' subjective reasoning for discharging patients with CSAEs (study group) and without CSAEs (control group)’ and ‘objective evaluation of CSAEs by senior EPs, using clinical evidences such as recording history, physical examinations, laboratory/radiological examinations and observation of inadequacies in the basic management process (such as recording history, physical examinations, laboratory/radiological examinations and observation) as the guide’. Subjective reasons for discharging patients’ improvement of symptoms, and the certainty of safety of the discharge were compared in the two groups using χ2 statistics or t test.ResultsOf the 20 512 discharged cases, there were 1370 return visits (6.7%, 95% CI 6.3% to 7%) and 165 CSAEs due to physicians' factors (0.82%, 95% CI 0.75% to 0.95%). In comparisons between the study group and the control group, only some components of discharge reasoning showed a significant difference (p<0.001). Inadequacies in the basic management process were the main cause of CSAEs (164/165).ConclusionThe authors recommended that EP follow-up of the basic management processes (including history record, physical examination, laboratory and radiological examinations, clinical symptoms/signs and treatment) using clinical evidence as a guideline should be made mandatory.

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Section: Discussionsupporting

confidence: 81%

Evaluation of clinically significant adverse events in patients discharged from a tertiary-care emergency department in Taiwan

et al. 2012

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“…[3][4][5] As with other health professions, it is important to understand how paramedics make decisions so that adverse events related to clinical judgment can be reduced or prevented.…”

Section: Introductionmentioning

confidence: 99%

A Survey to Determine Decision-Making Styles of Working Paramedics and Student Paramedics

Jensen

Bienkowski

Travers

et al. 2016

CJEM

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Objective: Two major processes underlie human decisionmaking: experiential (intuitive) and rational (conscious) thinking. The predominant thinking process used by working paramedics and student paramedics to make clinical decisions is unknown. Methods: A survey was administered to ground ambulance paramedics and to primary care paramedic students. The survey included demographic questions and the Rational Experiential Inventory-40, a validated psychometric tool involving 40 questions. Twenty questions evaluated each thinking style: 10 assessed preference and 10 assessed ability to use that style. Responses were provided on a five-point Likert scale, with higher scores indicating higher affinity for the style in question. Analysis included both descriptive statistics and t tests to evaluate differences in thinking style. Results: The response rate was 88.4% (1172/1326). Paramedics (n = 904) had a median age of 36 years (IQR 29-42) and most were male (69.5%) and primary or advanced care paramedics (PCP = 55.5%; ACP = 32.5%). Paramedic students (n = 268) had a median age of 23 years (IQR 21-26), most were male (63.1%) and had completed high school (31.7%) or an undergraduate degree (25.4%) prior to paramedic training. Both groups scored their ability to use and favourability toward rational thinking significantly higher than experiential thinking. The mean score for rational thinking was 3.86/5 among paramedics and 3.97/5 among paramedic students (p < 0.001). The mean score for experiential thinking was 3.41/5 among paramedics and 3.35/5 among paramedic students (p = 0.06). Conclusion: Working paramedics and student paramedics prefer and perceive that they have the ability to use rational over experiential thinking. This information adds to our current knowledge on paramedic decision-making and is potentially important for developing continuing education and clinical support tools. RÉSUMÉObjectif: Deux grands processus sous-tendent les prises de décision chez l'homme : la pensée expérientielle (intuitive) et la pensée rationnelle (consciente). Toutefois, l'on ne sait pas à quel mode de pensée recourent principalement les ambulanciers paramédicaux et les étudiants en technique paramédi-cale dans leurs prises de décision d'ordre clinique. Méthode: Une enquête a été menée parmi des ambulanciers paramédicaux et des étudiants en soins préhospitaliers de base. Le questionnaire se composait d'une collecte de données démographiques ainsi que d'un outil psychométri-que validé de 40 questions, le Rational Experiential Inventory-40 (inventaire rationnel-expérientiel). Vingt questions portaient sur chacun des modes de pensée : dix sur le mode de prédilection et dix sur la capacité d'utiliser ce mode. Les réponses étaient cotées sur une échelle de Likert à 5 points, et les scores plus élevés indiquaient une préférence pour le mode en question. Une analyse s'appuyant sur des statistiques descriptives et des tests t a été réalisée afin de faire ressortir les différences entre les modes de pensée. Résultats: Le taux de rép...

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“…Reasons include high patient volume, patient acuity and complexity, a work environment characterized by time constraints, multiple interruptions and disrupted sleep cycles for health care workers, as well as factors such as high risk diagnostic and therapeutic interventions and variable levels of physician training [8], [9], [10], [11]. While population based estimates from the seminal Harvard Medical Practice Study (HMPS) suggest that about 3% of AE occur in the emergency department (ED), this is likely an underestimation given that the study included only hospitalized patients [8] and only 9.5% of patients who visit an ED are admitted [12].…”

Section: Introductionmentioning

confidence: 99%

Adverse Events Related to Emergency Department Care: A Systematic Review

et al. 2013

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ObjectiveTo systematically review the literature regarding the prevalence, preventability, severity and types of adverse events (AE) in the Emergency Department (ED).MethodsWe systematically searched major bibliographic databases, relevant journals and conference proceedings, and completed reference reviews of primary articles. Observational studies (cohort and case-control), quasi-experimental (e.g. before/after) studies and randomized controlled trials, were considered for inclusion if they examined a broad demographic group reflecting a significant proportion of ED patients and described the proportion of AE. Studies conducted outside of the ED setting, those examining only a subpopulation of patients (e.g. a specific entrance complaint or receiving a specific intervention), or examining only adverse drug events, were excluded. Two independent reviewers assessed study eligibility, completed data extraction, and assessed study quality with the Newcastle Ottawa Scale.ResultsOur search identified 11,624 citations. Ten articles, representing eight observational studies, were included. Methodological quality was low to moderate with weaknesses in study group comparability, follow-up, and outcome ascertainment and reporting. There was substantial variation in the proportion of patients with AE related to ED care, ranging from 0.16% (n = 9308) to 6.0% (n = 399). Similarly, the reported preventability of AE ranged from 36% (n = 250) to 71% (n = 24). The most common types of events were related to management (3 studies), diagnosis (2 studies) and medication (2 studies).ConclusionsThe variability in findings and lack of high quality studies on AE in the high risk ED setting highlights the need for research in this area. Further studies with rigorous, standardized outcome assessment and reporting are required.

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Adverse events among patients registered in high-acuity areas of the emergency department: a prospective cohort study

Cited by 64 publications

References 21 publications

Evaluation of clinically significant adverse events in patients discharged from a tertiary-care emergency department in Taiwan

Evaluation of clinically significant adverse events in patients discharged from a tertiary-care emergency department in Taiwan

A Survey to Determine Decision-Making Styles of Working Paramedics and Student Paramedics

Adverse Events Related to Emergency Department Care: A Systematic Review

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