Executive Summary
Nearly one-third of all diagnostic errors took place in the emergency department (ED), according to a recent report. Half of the errors resulted in death.
- The fast pace in the ED contributes to diagnostic errors.
- Obtaining a proper history is key to avoiding diagnostic errors.
- Infections and strokes are the most common malpractice issues in the ED.
By Greg Freeman
An analysis of closed medical malpractice cases from 2019 to 2023 found that 28% of all diagnostic errors took place in the emergency department (ED), suggesting opportunities for hospitals to focus their efforts in reducing the pernicious problem.
The ED is the second-most frequent location for diagnostic error allegations, but the large number of high-acuity patients and the fast-paced environment make it particularly risky, says Dana Siegal, vice president of risk management with Coverys, a malpractice insurer based in Boston.
Over a five-year period, diagnostic error contributed to 26% of Coverys’ medical malpractice claims but accounted for 41% of indemnity paid. The highest percentage of diagnostic-related malpractice claims occur in ambulatory care settings, while EDs and urgent care clinics are the second-most frequent source of diagnostic-related claims.
The review of ED claims found that failure to obtain an adequate history and physical is the most frequent contributor to diagnostic error in the ED. The data show that that 52% of diagnosis-related events in the ED resulted in death (36%) or a high-severity injury (16%). Events involving death accounted for 51% of the indemnity paid. (The full report is available online at https://bit.ly/3NKLyKv.)
“The biggest part of this is that we still have some work to do around the mitigation of diagnostic errors within our industry. We’ve been studying these issues for quite some time, and I think we’ve made some progress in different areas, but I think we all know that the cases still continue to happen,” Siegal says.
The ED is prone to diagnostic errors beyond the typical risks posed in other settings because of the fast pace and emergent conditions, Siegal notes.
“While history and physical taking is a key vulnerability in all diagnostic arenas, in the ED, it has a higher need and a shorter timeline where the providers need to really focus on questions like, ‘Is the patient coherent? Can they tell their own story? Do you need to be accessing family in the waiting room? Can you get to a medical record? Are there other providers that can provide you more history?’” she says. “It is urgent and rapid fire in order to gather the information that you need. The key takeaway from that is that you need to get as much of the history in place in order to then order the right test, assess the patient rapidly, and then know whether this is a case in which a patient is acute and needs to be admitted for additional follow-up, or whether it is safe to do an assessment, a resolve, and discharge.”
Siegal notes that heart attacks and appendicitis used to be two of the key diagnoses that led to medical malpractice events in the ED, but the current data indicate that the two primary areas are infection and strokes, with orthopedic injuries being third.
Source
- Dana Siegal, Vice President of Risk Management, Coverys, Boston. Telephone: (800) 225-6168.
Greg Freeman has worked with Relias Media and its predecessor companies since 1989, moving from assistant staff writer to executive editor before becoming a freelance writer. He has been the editor of Healthcare Risk Management since 1992 and provides research and content for other Relias Media products. In addition to his work with Relias Media, Greg provides other freelance writing services and is the author of seven narrative nonfiction books on wartime experiences and other historical events.
An analysis of closed medical malpractice cases from 2019 to 2023 found that 28% of all diagnostic errors took place in the emergency department, suggesting opportunities for hospitals to focus their efforts in reducing the pernicious problem.
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