Adverse Events Related to Emergency Department Care: A Systematic Review

Stang, Antonia; Wingert, Aireen; Hartling, Lisa; Plint, Amy C.

doi:10.1371/journal.pone.0074214

Cited by 92 publications

(86 citation statements)

References 31 publications

(145 reference statements)

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“…Therefore, mild reactions such as nausea or dizziness are underrepresented in this data set. However, our adverse drug event rate of 0.31% was similar to that of other studies conducted in the ED, which range from 0.16% to 6.0%, 31 suggesting that we captured the majority of clinically significant adverse drug events. The external validity of this study is limited by heterogeneity across computerized provider order entry and clinical decision support systems.…”

Section: Limitationssupporting

confidence: 82%

“…According to previous research, adverse drug event occurrence ranges from 0.16% to 6.0% in the ED. 31 Using this range, 5,000 chart reviews were expected to capture between 6 and 300 adverse drug events, resulting in a manageable number of chart reviews across all days of the week while maintaining enough volume to capture adverse drug events. In adherence with the Health Insurance Portability and Accountability Act (HIPAA) regulations and local institutional review board requirements, all ED visits for patients aged 18 to 89 years were included.…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Clinically Inconsequential Alerts: The Characteristics of Opioid Drug Alerts and Their Utility in Preventing Adverse Drug Events in the Emergency Department

Genco

Forster

Flaten

et al. 2016

Annals of Emergency Medicine

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Study objective We examine the characteristics of clinical decision support alerts triggered when opioids are prescribed, including alert type, override rates, adverse drug events associated with opioids, and preventable adverse drug events. Methods This was a retrospective chart review study assessing adverse drug event occurrences for emergency department (ED) visits in a large urban academic medical center using a commercial electronic health record system with clinical decision support. Participants include those aged 18 to 89 years who arrived to the ED every fifth day between September 2012 and January 2013. The main outcome was characteristics of opioid drug alerts, including alert type, override rates, opioid-related adverse drug events, and adverse drug event preventability by clinical decision support. Results Opioid drug alerts were more likely to be overridden than nonopioid alerts (relative risk 1.35; 95% confidence interval [CI] 1.21 to 1.50). Opioid drug-allergy alerts were twice as likely to be overridden (relative risk 2.24; 95% CI 1.74 to 2.89). Opioid duplicate therapy alerts were 1.57 times as likely to be overridden (95% CI 1.30 to 1.89). Fourteen of 4,581 patients experienced an adverse drug event (0.31%; 95% CI 0.15% to 0.47%), and 8 were due to opioids (57.1%). None of the adverse drug events were preventable by clinical decision support. However, 46 alerts were accepted for 38 patients that averted a potential adverse drug event. Overall, 98.9% of opioid alerts did not result in an actual or averted adverse drug event, and 96.3% of opioid alerts were overridden. Conclusion Overridden opioid alerts did not result in adverse drug events. Clinical decision support successfully prevented adverse drug events at the expense of generating a large volume of inconsequential alerts. To prevent 1 adverse drug event, providers dealt with more than 123 unnecessary alerts. It is essential to refine clinical decision support alerting systems to eliminate inconsequential alerts to prevent alert fatigue and maintain patient safety.

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Section: Limitationssupporting

confidence: 82%

Section: Methodsmentioning

confidence: 99%

Clinically Inconsequential Alerts: The Characteristics of Opioid Drug Alerts and Their Utility in Preventing Adverse Drug Events in the Emergency Department

Genco

Forster

Flaten

et al. 2016

Annals of Emergency Medicine

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“…Anderson et al showed an overall incidence of error at 0.13% in ED care 6. Overall, there is a dearth of high-quality evidence describing the incidence of error and adverse events in the ED 10. The Anderson study, reviewing only physician complaints about ED patient care, found that 22.6% of the errors identified were identified by complaints and 19.9% of adverse events were identified by complaints, although the proportion that were preventable was not reported 6…”

Section: Discussionmentioning

confidence: 99%

Use of Physician Concerns and Patient Complaints as Quality Assurance Markers in Emergency Medicine

Gurley¹,

Wolfe²,

Burstein³

et al. 2016

WestJEM

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IntroductionThe value of using patient- and physician-identified quality assurance (QA) issues in emergency medicine remains poorly characterized as a marker for emergency department (ED) QA. The objective of this study was to determine whether evaluation of patient and physician concerns is useful for identifying medical errors resulting in either an adverse event or a near-miss event.MethodsWe conducted a retrospective, observational cohort study of consecutive patients presenting between January 2008 and December 2014 to an urban, tertiary care academic medical center ED with an electronic error reporting system that allows physicians to identify QA issues for review. In our system, both patient and physician concerns are reviewed by physician evaluators not involved with the patients’ care to determine if a QA issue exists. If a potential QA issue is present, it is referred to a 20-member QA committee of emergency physicians and nurses who make a final determination as to whether or not an error or adverse event occurred.ResultsWe identified 570 concerns within a database of 383,419 ED presentations, of which 33 were patient-generated and 537 were physician-generated. Out of the 570 reports, a preventable adverse event was detected in 3.0% of cases (95% CI = [1.52–4.28]). Further analysis revealed that 9.1% (95% CI = [2–24]) of patient complaints correlated to preventable errors leading to an adverse event. In contrast, 2.6% (95% CI = [2–4]) of QA concerns reported by a physician alone were found to be due to preventable medical errors leading to an adverse event (p=0.069). Near-miss events (errors without adverse outcome) trended towards more accurate reporting by physicians, with medical error found in 12.1% of reported cases (95% CI = [10–15]) versus 9.1% of those reported by patients (95% CI = [2–24] p=0.079). Adverse events in general that were not deemed to be due to preventable medical error were found in 12.1% of patient complaints (95% CI = [3–28]) and in 5.8% of physician QA concerns (95% CI = [4–8]).ConclusionScreening and systemized evaluation of ED patient and physician complaints may be an underutilized QA tool. Patient complaints demonstrated a trend to identify medical errors that result in preventable adverse events, while physician QA concerns may be more likely to uncover a near miss.

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“…Prior studies suggest that up to 10% of patients admitted to ED experience medication errors during their ED stay. Even 70% of these mistakes could have been prevented 7 8…”

Section: Introductionmentioning

confidence: 99%