Causes of Diagnostic Errors Leading to Harm in Emergency Department; a Brief Report
Iranian Journal of Emergency Medicine,
Vol. 6 No. 1 (2019),
23 February 2019
,
Page e17
https://doi.org/10.22037/ijem.v6i1.28349
Abstract
Introduction: Despite the considerable advances in medical diagnosis and treatment, treatment staff errors show an increasing trend, which can lead to decline in people’s trust and rise in stress and anxiety among patients. The present study was performed with the aim of assessing the causes of diagnostic errors leading to complaints from emergency medicine specialists from 2012 to 2017 .Methods: In the present cross-sectional study, 100 files that were referred to the forensic medicine unit were evaluated. The data gathering tool was a researcher-made checklist, using which the demographic data of the patients and the type of error were extracted from the patients’ profiles. Data were coded and entered to SPSS software, version 20, after gathering and then reported using descriptive statistics. Results: In this study, the medical profiles of 100 patients who had filed complaints due to medical errors, in which a medical error was confirmed, were evaluated. In terms of sex distribution, 67% of the patients were male and 50% of the individuals were in the 30 – 59 years age range. 32% of the errors were due to the physician not ordering laboratory tests, 37% were due to errors in examination, and 31 were due to errors in interpretation of the test results. In the level of diagnostic error and ordering diagnostic tests, the most important cause of error was that the physician did not believe testing was necessary for diagnosis. In the stage of examination and history taking also incomplete physical examination by the physician was the most important cause of error. Among the most important factors affecting medical error incidence in the studied files, judgment with 58%, changing shifts without providing information about the patients with 45%, workload with 38%, and the patient not cooperating with 29% were the most important cognitive, communicative, systemic, and patient-related factors, respectively. Conclusion: Error in judgment regarding need for ordering diagnostic tests or further imaging, error in shift handover and not providing information regarding the patients for the next shift, overcrowding and heavy workload in the emergency department, and patients not cooperating were among the most important underlying factors in incidence of errors in the emergency department.
- Malpractice
- forensic medicine
- diagnostic errors
- medical errors
How to Cite
References
Najafi H, editor Medication prescription error is one of the most common errors in medical professional. Proceedings of the 1st International Congress of Forensic Medicine; 2009.
Ghamari Zare Z, Purfarzad Z, Ghorbani M, Zamani M. Factors Affecting Learning of Pharmaceutical Care in Clinical Education: Arak Nursing Students’ Perspectives. Iranian Journal of Medical Education. 2012;12(4):265-73.
Chakravarty A, Sahu A, Biswas M, Chatterjee K, Rath S. A study of assessment of patient safety climate in tertiary care hospitals. medical journal armed forces india. 2015;71(2):152-7.
Organization WH. Patient safety toolkit. Geneva: World Health Organization, Regional Office for the Eastern Mediterranean; 2015. 2016.
Haghshenas MR, Amiri AA, Vahidshahi K, Rezaee MS, Rahmani N, Pourhossen M, et al. The frequency of malpractice lawsuits referred to forensic medicine department and medical council. J MazandaranUniv Med Sci. 2012;22(86):244-51.
Siabani S, Alipour AA, Siabani H, Rezaei M, Daniali S. A survey of complaints against physicians reviewed at Kermanshah. Journal of Kermanshah University of Medical Sciences (J Kermanshah Univ Med Sci). 2009;13(1).
Cloete L. Reducing medication errors in nursing practice. Cancer Nursing Practice. 2015;14(1).
Studdert DM, Mello MM, Gawande AA, Gandhi TK, Kachalia A, Yoon C, et al. Claims, errors, and compensation payments in medical malpractice litigation. New England journal of medicine. 2006;354(19):2024-33.
Schenkel S. Promoting patient safety and preventing medical error in emergency departments. Academic Emergency Medicine. 2000;7(11):1204-22.
Sandars J, Esmail A. The frequency and nature of medical error in primary care: understanding the diversity across studies. Family practice. 2003;20(3):231-6.
Schwappach DL, Koeck CM. What makes an error unacceptable? A factorial survey on the disclosure of medical errors. International Journal for Quality in Health Care. 2004;16(4):317-26.
Tamuz M, Thomas E, Franchois K. Defining and classifying medical error: lessons for patient safety reporting systems. BMJ Quality & Safety. 2004;13(1):13-20.
Ehsani SR, Cheraghi MA, Nejati A, Salari A, Esmaeilpoor AH, Nejad EM. Medication errors of nurses in the emergency department. Journal of medical ethics and history of medicine. 2013;6.
Weant KA, Bailey AM, Baker SN. Strategies for reducing medication errors in the emergency department. Open access emergency medicine: OAEM. 2014;6:45.
Scott BM, Considine J, Botti M. Medication errors in ED: Do patient characteristics and the environment influence the nature and frequency of medication errors? Australasian emergency nursing journal. 2014;17(4):167-75.
Makary MA, Daniel M. Medical error—the third leading cause of death in the US. Bmj. 2016;353:i2139.
Kee JW, Khoo HS, Lim I, Koh MY. Communication skills in patient-doctor interactions: learning from patient complaints. Health Professions Education. 2018;4(2):97-106.
Bianchin C, Prevaldi C, Corradin M, Saia M. Medical malpractice claim risk in emergency departments. Emergency Care Journal. 2018;14(1).
Frakes M, Jena AB. Does medical malpractice law improve health care quality? Journal of public economics. 2016;143:142-58.
Stamm JA, Korzick KA, Beech K, Wood KE. Medical malpractice: reform for today's patients and clinicians. The American journal of medicine. 2016;129(1):20-5.
Gandhi TK, Kachalia A, Thomas EJ, Puopolo AL, Yoon C, Brennan TA, et al. Missed and delayed diagnoses in the ambulatory setting: a study of closed malpractice claims. Annals of internal medicine. 2006;145(7):488-96.
Wahls TL, Cram PM. The frequency of missed test results and associated treatment delays in a highly computerized health system. BMC family practice. 2007;8(1):32.
Schiff GD, Hasan O, Kim S, Abrams R, Cosby K, Lambert BL, et al. Diagnostic error in medicine: analysis of 583 physician-reported errors. Archives of internal medicine. 2009;169(20):1881-7.
Carroll AE, Buddenbaum JL. Malpractice claims involving pediatricians: epidemiology and etiology. Pediatrics. 2007;120(1):10-7.
Traina F. Medical malpractice: the experience in Italy. Clinical orthopaedics and related research. 2009;467(2):434-42.
Brennan TA, Sox CM, Burstin HR. Relation between negligent adverse events and the outcomes of medical-malpractice litigation. New England Journal of Medicine. 1996;335(26):1963-7.
Studdert DM, Mello MM, Gawande AA, Brennan TA, Wang YC. Disclosure of medical injury to patients: an improbable risk management strategy. Health Affairs. 2007;26(1):215-26.
Hunt M, Glucksman M. A review of 7 years of complaints in an inner-city accident and emergency department. Emergency Medicine Journal. 1991;8(1):17-23.
Jafarian A, Parsapoor A, Hajtarkhani A, Asghari F, Imami Razavi SH, Yalda A. An survey on the complaints registered in Medical Council Organization of Tehran. Iranian Journal of Medical Ethics and History of Medicine. 2009;2(2):67-74.
- Abstract Viewed: 282 times
- PDF (فارسی) Downloaded: 100 times
- HTML (فارسی) Downloaded: 54 times
