In a recent study, researchers from the University of Wisconsin have examined why doctors make medical errors in an emergency department environment.
Medical error is a leading cause of death nationwide. It is estimated to cause 250,000 deaths per year in the US.
The emergency department is a very different clinical environment from the inpatient wards, with frequent interruptions and often incomplete or unreliable information.
While systems issues have been closely checked as a contributor to error, little is known about what contribute to diagnostic errors.
To solve the puzzle, in the study, the researchers examined 8 months of patient revisits within 72 h in which patients were admitted on their second visit.
Among them, 52 cases of confirmed error were identified and classified using a modified version of the Australian Patient Safety Foundation classification system for medical errors by a group of trained physicians.
The researchers found that faulty information processing was the most frequently identified category of error (45% of cases), followed by faulty verification (31%).
Faulty knowledge (6%) and faulty information gathering (18%) occurred relatively infrequently.
“Misjudging the salience of a finding” and “premature closure” were the individual errors that occurred most frequently (13%).
In addition, the team found that patients with abdominal complaints may be particularly vulnerable to these errors.
The team concluded that despite the complex nature of diagnostic reasoning, cognitive errors of information processing appear to occur at higher rates than other errors.
Cognitive errors also happen in a similar pattern to an internal medicine service despite a different clinical environment.
Further research is needed to elucidate why these errors occur and how to mitigate them.
Lead author of the study is Benjamin Schnapp of the University of Wisconsin.
The study is published in the Journal Diagnosis.
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Journal reference: Benjamin H. Schnapp et al. Cognitive error in an academic emergency department. Journal Diagnosis (2018). https://doi.org/10.1515/dx-2018-0011
