AHRQ Study: Process Breakdowns Cause Two-Thirds of Abdominal Pain Diagnostic Errors in Emergency Departments

More than two-thirds of diagnostic errors involving abdominal pain in the emergency department (ED) involved breakdowns in communication between patients and clinicians, according to a new AHRQ-funded study. The study, funded in part by AHRQ, reviewed a high-risk cohort of patients presenting to the ED with abdominal pain to evaluate for possible diagnostic errors and associated process breakdowns. Researchers found that diagnostic errors occurred in 35 of 100 high-risk cases. More than two-thirds had breakdowns involving the patient–provider encounter (most commonly history-taking or ordering additional tests) and/or follow-up and tracking of diagnostic information (most commonly follow-up of abnormal test results). The most frequently missed diagnoses were gallbladder pathology and urinary infections. Read anabstract of the study, which was published in Emergency Medicine Journal.

2015 Nov 3. pii: emermed-2015-204754. doi: 10.1136/emermed-2015-204754. [Epub ahead of print]

Diagnostic errors related to acute abdominal pain in the emergency department.

Medford-Davis L1, Park E2, Shlamovitz G3, Suliburk J4, Meyer AN5, Singh H5.

Author information

Abstract

OBJECTIVE:

Diagnostic errors in the emergency department (ED) are harmful and costly. We reviewed a selected high-risk cohort of patients presenting to the ED with abdominal pain to evaluate for possible diagnostic errors and associated process breakdowns.

DESIGN:

We conducted a retrospective chart review of ED patients >18 years at an urban academic hospital. A computerised 'trigger' algorithm identified patients possibly at high risk for diagnostic errors to facilitate selective record reviews. The trigger determined patients to be at high risk because they: (1) presented to the ED with abdominal pain, and were discharged home and (2) had a return ED visit within 10 days that led to a hospitalisation. Diagnostic errors were defined as missed opportunities to make a correct or timely diagnosis based on the evidence available during the first ED visit, regardless of patient harm, and included errors that involved both ED and non-ED providers. Errors were determined by two independent record reviewers followed by team consensus in cases of disagreement.

RESULTS:

Diagnostic errors occurred in 35 of 100 high-risk cases. Over two-thirds had breakdowns involving the patient-provider encounter (most commonly history-taking or ordering additional tests) and/or follow-up and tracking of diagnostic information (most commonly follow-up of abnormal test results). The most frequently missed diagnoses were gallbladder pathology (n=10) and urinary infections (n=5).

CONCLUSIONS:

Diagnostic process breakdowns in ED patients with abdominal pain most commonly involved history-taking, ordering insufficient tests in the patient-provider encounter and problems with follow-up of abnormal test results.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/