The nature and occurrence of registration errors in the emergency department

Abstract

Research into the nature and occurrence of medical errors has shown that these often result from a combination of factors that lead to the breakdown of workflow. Nowhere is this more critical than in the emergency department (ED), where the focus of clinical decision is on the timely evaluation and stabilization of patients. This paper reports on the nature of errors and their implications for patient safety in an adult ED, using methods of ethnographic observation, interviews, and think-aloud protocols. Data were analyzed using modified "grounded theory," which refers to a theory developed inductively from a body of data. Analysis revealed four classes of errors, relating to errors of misidentification, ranging from multiple medical record numbers, wrong patient identification or address, and in one case, switching of one patient's identification information with those of another. Further analysis traced the root of the errors to ED registration.These results indicate that the nature of errors in the emergency department are complex, multilayered and result from an intertwined web of activity, in which stress of the work environment, high patient volume and the tendency to adopt shortcuts play a significant role. The need for information technology (IT) solutions to these problems as well as the impact of alternative policies is discussed.

Antecedents for safety in health IT: An exploratory investigation

“…The data collection was conducted in hospital or at clinical sites for most of the studies. [5] • Video observation 10 medicine physicians Not stated [9] • Interview • Observation 20 pharmacist 5 pharmacies [12] • Document analysis 116 records Not stated [13] • Case study Not stated Hospital: Emergency department [14] • Document analysis 484 reports Not stated [15] • Interview 110 care staff members 9 residential aged care homes [16] • User testing • Interview • Observation 92 3 rd and 4 th year dental students 2 clinical sites [17] • Observations • Interviews 9 internal medicine faculty members Academic-affiliated ambulatory care clinic from [18] • Observations • Interviews 16 healthcare worker 9 specialty clinics and 3 primary care clinics [19] • Questionnaire 3929 physicians Healthcare centers, public secondary and tertiary care hospitals [20] • [20]…”

“…Another example of the impact of inappropriate functionality is a patient with two record numbers. The system can only match records if the content is an exact match, else the patients were given new record numbers despite the patient record has been recorded in the system [20]. Thus, missing functionality or incompatibilities with the work caused incorrect or incomplete clinical process which lead to adverse event to a patient.…”

Human factors in emergency care

“…12 All stages in the patient's journey through the ED can benefit from human factors analysis. 13,14 The introduction of new technologies into the ED requires an analysis of how the technology influences workflow to ensure that the needs of the user are met and that no new errors are introduced. For example, the addition of health information technology (health IT) can have an effect on workflow, including how staff communicates and the way that teams operate; health IT is discussed in greater detail later.…”

The role of the emergency medical dispatch centre (EMDC) and prehospital emergency care safety: results from an incident report (IR) system

“…Personnel working in this setting have to struggle with time constraints and with acute patient conditions potentially subject to unpredictable changes. 1 In order to ensure faster and safer provision of emergency care, rescue operations must be coordinated. This coordination is carried out in Italy by the emergency medical dispatch centre (EMDC).…”