Missed and Delayed Diagnoses in the Emergency Department: A Study of Closed Malpractice Claims From 4 Liability Insurers

Kachalia, Allen; Gandhi, Tejal K.; Puopolo, Ann Louise; Yoon, Catherine; Thomas, Eric J.; Griffey, Richard T.; Brennan, Troyen A.; Studdert, David M.

doi:10.1016/j.annemergmed.2006.06.035

Cited by 417 publications

(339 citation statements)

References 57 publications

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“…Focusing on improving physician education about neurological emergencies may decrease this type of error. A review of malpractice claims found that residents were involved in 56% of the cases and that in 75% of these cases, trainees had the highest contributory rate of any personnel involved [4]. Because the residents and attending emergency physicians are jointly involved in the decision-making process, our data do not allow us to assign these errors to one group or the other.…”

Section: Discussioncontrasting

confidence: 39%

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Types of diagnostic errors in neurological emergencies in the emergency department

et al. 2014

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Background: Neurological emergencies often pose diagnostic challenges for emergency physicians because these patients often present with atypical symptoms and standard imaging tests are imperfect. Misdiagnosis occurs due to a variety of errors. These can be classified as knowledge gaps, cognitive errors, and systems-based errors. The goal of this study was to describe these errors through review of quality assurance (QA) records. Methods: This was a retrospective pilot study of patients with neurological emergency diagnoses that were missed or delayed at one urban, tertiary academic emergency department. Cases meeting inclusion criteria were identified through review of QA records. Three emergency physicians independently reviewed each case and determined the type of error that led to the misdiagnosis. Proportions, confidence intervals, and a reliability coefficient were calculated. Results: During the study period, 1168 cases were reviewed. Forty-two cases were found to include a neurological misdiagnosis and twenty-nine were determined to be the result of an error. The distribution of error types was as follows: knowledge gap 45.2% (95% CI 29.2, 62.2), cognitive error 29.0% (95% CI 15.9, 46.8), and systems-based error 25.8% (95% CI 13.5, 43.5). Cerebellar strokes were the most common type of stroke misdiagnosed, accounting for 27.3% of missed strokes. Conclusions: All three error types contributed to the misdiagnosis of neurological emergencies. Misdiagnosis of cerebellar lesions and erroneous radiology resident

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Section: Discussioncontrasting

confidence: 39%

“…Failure to make a diagnosis can result in patient harm and is a leading source of medical malpractice claims [3,4]. Conversely, excessive workups and over-diagnosis may also lead to patient harm and inefficient resource utilization.…”

Section: Introductionmentioning

confidence: 99%

Types of diagnostic errors in neurological emergencies in the emergency department

et al. 2014

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“…Some authors have introduced the "pre-pre-" and "post-post-" analytical phases to identify activities associated with the initial selection of tests and with the interpretation by clinicians respectively, to differentiate them for the pure collection/transport activities (pre-analytical phase) and reporting (postanalytical phase) 13, 14 . There is some evidence that these steps are more error-prone than other pre-and postanalytical activities [13][14][15][16][17][18] .However, the definition and use of such terms is not universal. Indeed the definition of even basic terms such as pre-analytical, analytical and post-analytical can vary between authorities.…”

Section: Introductionmentioning

confidence: 99%

Errors in laboratory medicine: The role of quality indicators

Mohanty¹

2020

IJCBR

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Errors in laboratory are heterogeneous in nature as it involves various complex procedures and a variety of persons preforming all the processes, starting from ordering of tests to reporting of result to its influence on ultimate patient care. The core job of a laboratory is to produce the correct test result. If we can't get the test results right, then we aren't doing our core job. It's our profession to know all the details of testing and instrumentation and quality control. It's our profession to assure that test results are correct. Improvements need not be only at "pre" or "post" or "analytical" -it should be at all three stages, as the consequence of error in any of the stage is the same: poor patient care. No error is worse than the other. We must make efforts on all fronts. Even if this means making small improvements in each area, a unified improvement effort will achieve better test results and better patient care than narrow efforts in either the pre-, post-or analytical area. To have a uniform consensus, the laboratories should have certain quality indicators to have control over the procedures that tend to generate errors.

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“…Incorrect interpretation of diagnostic tests has been estimated as accounting for 37% of malpractice claims in primary care [93] and emergency departments [94]. The most common cognitive problems leading to fatal misdiagnosis involve faulty synthesis, particularly premature closure, i.e., the failure to continue considering reasonable alternatives after an initial diagnosis was reached [95].…”

Section: Ensuring Clinical Valuementioning

confidence: 99%

Performance criteria of the post-analytical phase

Sikaris¹

2015

Clinical Chemistry and Laboratory Medicine (CCLM)

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Quality in healthcare is ideally at an optimal benchmark, but must be at least above the minimal standards for care. While laboratory quality is ideally judged in clinical terms, laboratory medicine has also used biological variations and state-of-the-art criteria when, as is often the case, clinical outcome studies or clinical consensus are not available. The post-analytical phase involves taking quality technical results and providing the means for clinical interpretation in the report. Reference intervals are commonly used as a basis for data interpretation; however, laboratories vary in the reference intervals they use, even when analysis is similar. Reference intervals may have greater clinical value if they are both optimised to account for physiological individuality, as well as if they are harmonised through professional consensus. Clinical decision limits are generally superior to reference intervals as a basis for interpretation because they address the specific clinical concern in any patient. As well as providing quality data and interpretation, the knowledge of laboratory experts can be used to provide targeted procedural knowledge in a patient report. Most profoundly critically abnormal results should to be acted upon to minimise the risk of mortality. The three steps in quality report interpretation, (i) describing the abnormal data, (ii) interpreting the clinical information within that data and (iii) providing knowledge for clinical follow-up, highlight that the quality of all laboratory testing is reflected in its impact on clinical management and improving patient outcomes.

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Missed and Delayed Diagnoses in the Emergency Department: A Study of Closed Malpractice Claims From 4 Liability Insurers

Cited by 417 publications

References 57 publications

Types of diagnostic errors in neurological emergencies in the emergency department

Types of diagnostic errors in neurological emergencies in the emergency department

Errors in laboratory medicine: The role of quality indicators

Performance criteria of the post-analytical phase

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