Emergency Department Errors: No Help Here

From the most recent Academic Emergency Medicine (Volume 12, Number 1 57-64) comes an article with a very intriguing title: Patient Concerns about Medical Errors in Emergency Departments. As a practicing EP I’m very interested in ED errors and their prevention. Unfortunately, there’s nothing here to help; fortunately, no-one but residency directors reads this journal anyway. (But more than read this site, so my snarkyness loses edge).

The article itself isn’t bad, but the problem is that the “errors” that are presented are heresay and unsubstantiated, leading to the conclusion that the ED is a hugely error-prone place to be. It may or may not be, and this isn’t going to settle the matter.

The article, with my comments:

Objective: Despite large numbers of emergency encounters, little is known about how emergency department (ED) patients conceptualize their risk of medical errors. This study examines how safe ED patients feel from medical errors, which errors are of greatest concern, how concerns differ by patient and hospital characteristics, and the relationship between concerns and willingness to return for future care.

That’s an interesting idea, and though I think that patients would be reluctant to return to any place where they percieve errors occurring (not just hospitals, but restaurants, etc), I think it’d be interesting to study.


Methods: Multiwave telephone interviews of 767 patients from 12 EDs were conducted. Patients were asked about their medical safety, concern about eight types of medical errors, and satisfaction with care.

I don’t know what a ‘multiwave’ telephone interview is; sounds cool, but expensive.


Results: Eighty-eight percent of patients believed that their safety from medical errors had been good, very good, or excellent; 38% of patients reported experiencing at least one specific error-related concern,

So, right now, there’s something important: 88% were happy with their safety from medical errors, but 38% thought an error had occurred. This is a good sign: patients realize the difference between minor and major error.

(Results, continued)… most commonly misdiagnosis (22% of all patients), physician errors (16%), medication errors (16%), nursing errors (12%), and wrong test/procedure (10%).

Hmmm. This is the part of this study that, if it’s ever read, could become urban legend: “38% errors, and 22% were misdiagnosis and 16% were other doc errors”. That’s a perception of error, but not necessarily reality.

Often, I give patients a diagnosis they don’t agree with, like “cold” when they believe their diagnosis is pneumonia (for example). Then, by not giving antibiotics for their cold (i.e., by not treating their pneumonia), I would have committed another error in this survey. So, this doesn’t mean patients are being misdiagnosed, but it does mean they percieve that they are, and it’s something we should better address (when we can, some patients are resistant to any answer they don’t want).


Conclusions: The majority of ED patients felt relatively safe from medical errors, yet a significant percentage of patients experienced concern about a specific error during their emergency encounter. Concerns varied by both patient and hospital characteristics and were highly linked to patient satisfaction. The selective nature of concerns may suggest that patients are attuned to cues they perceive to be linked to specific medical errors, but efforts to involve patients in error detection/prevention programs will be challenging given the stressful and intimidating nature of ED encounters.

Yes, it will be difficult to involve patients, and I don’t have a good answer to that. I do know that we’re doing a much better job about patient name bands, allergy bands, and doing the basic stuff (right patient/drug/route) thing.

The ED is going to be the hardest place to exorcise all errors. It’s a chaotic environment with no set pattern, the entire panoply of presentations and problems, from day zero to the last of life. It takes teamwork and compulsiveness to prevent errors. We’re trying.


Comments

  1. With only one exception, ER docs have been very astute in my experience. (which having 2 immune deficient boys, and myself with myasthenia gravis … my ER experience is vast).
    It was an ER doc that is responsible for me finally getting diagnosed after 6 mis diagnosis’ when the medical clinic I was going to was writing it off to chronic fatigue syndrome (“I’ve been treating this woman and her sons for over 2 years, watching her deteriorate by month by month … it is not Chronic fatigue syndrome, I’m admitting your patient! Get your residents down here NOW!” were his exact words)
    It was an ER doctor that put my fears to rest when I thought my youngest was having seizures … turned out to be tourette’s syndrome ..with a severe tic onset.
    It was an ER doc that made my first myasthenic crisis something that I could live through, and actually not have panic attacks at the same time.

    One ER doc scared me when she said MG was no big deal ..not much different than the common cold. I just chalked her up to having a bad day or getting her alphabet soup confused.

    I owe my life, quite literally to ER docs … in a very real sense … I owe my sanity to ER docs!!!!

  2. Goat Whacker says:

    Hard to give this “study” any credence. they called random patients and asked them about their perceptions apparently with no attempt to determine if they were valid or not. I guess the best you could say is that some patients thought there were some ED errors. Not much surprise there.

    My first thought was how many of the perceived medication errors involved failure to give Demerol as requested.