Misdiagnosis and failure to diagnose in emergency care: causes and empathy as a solution.

Thierry Pelaccia; Anne M Messman; Jeffrey A Kline

Commentary

Misdiagnosis and failure to diagnose in emergency care: causes and empathy as a solution.

November 11, 2020

Pelaccia T, Messman AM, Kline JA. Patient Edu Couns. 2020;103(8):1650-1656.

View more articles from the same authors.

The hectic and complex environment of emergency care can reduce diagnostic safety. This article discusses clinical reasoning and decision-making strategies used by emergency medicine physicians, contributing factors to diagnostic errors occurring in emergency medicine (e.g., overconfidence, cognitive stress, anchoring bias), and strategies to reduce the risk of error. A previous WebM&M commentary discussed an incident involving diagnostic delay in the emergency department.

PubMed citation

Available at

Related Resources From the Same Author(s)

Design of a safety dashboard for patients.

December 18, 2019

A scoping review of communication tools applicable to patients and their primary care providers after discharge from hospital.

July 14, 2021

Misdiagnosis in the emergency department: time for a system solution.

February 8, 2023

The aspects of healthcare quality that are important to health professionals and patients: a qualitative study.

December 15, 2021

'More than words' - interpersonal communication, cognitive bias and diagnostic errors.

August 11, 2021

Patient and clinician experiences of uncertainty in the diagnostic process: current understanding and future directions.

November 10, 2021

Engaging with ethnic minority consumers to improve safety in cancer services: a national stakeholder analysis.

May 25, 2022

How patients perceive a doctor's caring attitude.

September 24, 2008

Communication matters when it comes to adverse events: associations of adverse events during implant treatment with patients' communication quality and trust assessments.

March 15, 2023

Patient generated research priorities to improve diagnostic safety: a systematic prioritization exercise.

April 5, 2023

Communicating with patients about diagnostic errors in breast cancer care: providers' attitudes, experiences, and advice

January 22, 2020

Follow-up of abnormal screening mammograms among low-income ethnically diverse women: findings from a qualitative study.

December 8, 2008

More than words: patients' views on apology and disclosure when things go wrong in cancer care.

August 24, 2011

Communication about medical errors.

February 24, 2021

The impact of the COVID-19 pandemic on Emergency Department visits and patient safety in the United States.

August 26, 2020

Learning and mindfulness: improving perioperative patient safety.

April 19, 2017

Abdominal pain in the emergency department: missed diagnoses.

November 24, 2021

Measurement and monitoring patient safety in prehospital care: a systematic review.

February 24, 2021

Nurses' perceptions of open disclosure processes in cancer care: a cross-sectional study.

December 16, 2020

Misdiagnosis of heart failure: a systematic review of the literature.

July 28, 2021

Failure to rescue in neonatal care.

September 7, 2011

Fall prevention with the Smart Socks System reduces hospital fall rates.

September 7, 2022

Patient errors in use of injectable antidiabetic medications: a need for improved clinic-based education.

November 4, 2020

Patient safety in primary care: conceptual meanings to the health care team and patients.

November 25, 2020

The fusion of incident learning and failure mode and effects analysis for data-driven patient safety improvements.

March 17, 2021

Combined proactive risk assessment: unifying proactive and reactive risk assessment techniques in health care.

June 29, 2022

Incidence of prescription errors in patients discharged from the emergency department.

September 22, 2021

Prehospital naloxone and emergency department adverse events: a dose-dependent relationship.

November 25, 2020

Dual surgeon operating to improve patient safety.

September 29, 2021

'Care left undone' during nursing shifts: associations with workload and perceived quality of care.

August 14, 2013

Validity of unplanned admission to an intensive care unit as a measure of patient safety in surgical patients.

December 14, 2005

Home health staff perspectives on infection prevention and control: implications for Coronavirus Disease 2019.

December 23, 2020

Usability study of two common defibrillators reveals hazards.

January 2, 2008

Racial/ethnic inequities in pregnancy-related morbidity and mortality.

March 10, 2021

Adverse events among emergency department patients with cardiovascular conditions: a multicenter study.

March 10, 2021

"Good catch, Kiddo"--enhancing patient safety in the pediatric emergency department through simulation.

December 9, 2020

Adverse events during intrahospital transport of critically ill patients: a systematic review and meta-analysis.

February 9, 2022

Compensation claims in Danish emergency care: identifying hot spots and blind spots in the quality of care.

May 11, 2022

Misdiagnosis of thoracic aortic emergencies occurs frequently among transfers to aortic referral centers: an analysis of over 3700 patients.

October 12, 2022

The association of nursing home characteristics and quality with adverse events after a hospitalization.

April 28, 2021

Failure to rescue following emergency surgery: a FRAM analysis of the management of the deteriorating patient.

February 2, 2022

Analysis of risk factors for patient safety events occurring in the emergency department.

October 7, 2020

The role of feedback in emergency ambulance services: a qualitative interview study.

April 6, 2022

Tackling implicit bias in health care.

August 17, 2022

The accuracy of preliminary diagnoses made by paramedics - a cross-sectional comparative study.

October 7, 2020

Patient safety in the operating room.

September 21, 2023

Retrospective review for medication dose errors in pediatric emergency department medication orders that bypassed pharmacist review.

March 25, 2020

Nursing turbulence in critical care: relationships with nursing workload and patient safety.

May 27, 2020

Improving timely recognition and treatment of sepsis in the pediatric ICU.

May 27, 2020

Absence or presence: silent discourse in the operating room and impact on surgical team action.

November 11, 2020

Information concerning ICU patients’ families in the handover—the clinicians’ “game of whispers”: a qualitative study.

October 14, 2020

Nurses' perceived causes of medication administration errors: a qualitative systematic review.

November 25, 2020

Improving discharge safety in a pediatric emergency department.

October 26, 2022

Factors affecting patient safety culture among dental healthcare workers: A nationwide cross-sectional survey

October 16, 2019

Nurse staffing, burnout, and health care-associated infection.

August 15, 2012

Emergency department monitor alarms rarely change clinical management: an observational study.

September 16, 2020

Communication with health care workers regarding health care-associated exposure to coronavirus 2019: a checklist to facilitate disclosure.

June 24, 2020

Antibiotic prescribing errors in patients discharged from the pediatric emergency department.

March 30, 2022

Critical events during land-based interfacility transport.

February 12, 2014

When safety event reporting is seen as punitive: "I've been PSN-ed!"

September 9, 2020

Prescribing patterns of heart failure-exacerbating medications following a heart failure hospitalization.

February 12, 2020

COVID-19 has united patients and providers against institutional betrayal in health care: a battle to be heard, believed, and protected.

August 19, 2020

A new index for obstetrics safety and quality of care: integrating cesarean delivery rates with maternal and neonatal outcomes.

June 1, 2022

Use of an audit with feedback implementation strategy to promote medication error reporting by nurses.

November 25, 2020

Undiagnosed and rare diseases in critical care: the role of diagnostic access.

July 27, 2022

Electronic medical record-based interventions to encourage opioid prescribing best practices in the emergency department.

September 30, 2020

Variability in collection and use of race/ethnicity and language data in 93 pediatric hospitals.

October 14, 2020

Semantically ambiguous language in the teaching operating room.

December 15, 2021

Educating for Safety.

October 5, 2011

Lessons from walking the medical distancing tightrope.

July 22, 2020

What safety events are reported for ambulatory care? Analysis of incident reports from a patient safety organization.

October 21, 2020

Addressing systemic racism in nursing homes: a time for action.

April 14, 2021

Nurse bias and nursing care disparities related to patient characteristics: a scoping review of the quantitative and qualitative evidence

December 1, 2021

Internally-developed online adverse drug reaction and medication error reporting systems.

June 7, 2006

"Some version, most of the time": the surgical safety checklist, patient safety, and the everyday experience of practice variation.

January 19, 2022

Workarounds in the workplace: a second look.

August 12, 2015

Assessing resident and attending error and adverse events in the emergency department.

March 2, 2022

A comprehensive quality assurance program for personnel and procedures in radiation oncology: value of voluntary error reporting and checklists.

August 7, 2013

Are online patient reviews associated with health care outcomes? A systematic review of the literature.

June 23, 2021

Keeping patients at risk for self-harm safe in the emergency department: a protocolized approach.

December 2, 2020

Cognitive bias impact on management of postoperative complications, medical error, and standard of care.

November 4, 2020

Nurses' perceptions and demands regarding COVID-19 care delivery in critical care units and hospital emergency services.

December 2, 2020

Identifying errors and safety considerations in patients undergoing thrombolysis for acute ischemic stroke.

April 21, 2021

Coping with errors in the operating room: intraoperative strategies, postoperative strategies, and sex differences.

September 22, 2021

Speaking up behaviours (safety voices) of healthcare workers: a metasynthesis of qualitative research studies.

February 15, 2017

Factors associated with malpractice claim payout: an analysis of closed emergency department claims.

July 13, 2022

Accuracy of emergency department clinical findings for diagnosis of coronavirus disease 2019.

July 29, 2020

Tolerance of uncertainty and the practice of emergency medicine.

July 15, 2020

The safety of emergency care systems: results of a survey of clinicians in 65 US emergency departments.

March 4, 2009

Association of intraoperative anaesthesia handovers with patient morbidity and mortality: a systematic review and meta-analysis.

November 4, 2020

Implementation of a discharge education program to improve transitions of care for patients at high risk of medication errors.

February 19, 2020

Associations between safety outcomes and communication practices among pediatric nurses in the United States.

January 19, 2022

ESPEN guideline on hospital nutrition.

February 9, 2022

Omissions of care in nursing homes: a uniform definition for research and quality improvement.

November 18, 2020

Patient perceptions of safety in primary care: a qualitative study to inform care.

October 13, 2021

The physiology of failure: identifying risk factors for mortality in emergency general surgery patients using a regional health system integrated electronic medical record.

September 7, 2022

Oncologic errors in diagnostic radiology: a 10-year analysis based on medical malpractice claims.

November 10, 2021

Adverse events related to accidental unintentional ingestions from cough and cold medications in children.

August 26, 2020

Patient and hospital characteristics associated with delayed diagnosis of appendicitis.

February 1, 2023

Clinical diagnoses vs. autopsy findings in early deceased septic patients in the intensive care: a retrospective cohort study.

July 28, 2021

Related Resources

WebM&M Cases

Walking Out of a Hospital After Attempted Suicide

September 27, 2023

Understanding and Improving Diagnostic Safety in Ambulatory Care.

September 6, 2023

The AHRQ Report on Diagnostic Errors in the Emergency Department: the wrong answer to the wrong question.

June 28, 2023

Context matters: toward a multilevel perspective on context in clinical reasoning and error.

June 21, 2023

Patient safety in emergency departments: a problem for health care systems? An international survey.

June 21, 2023

Types of diagnostic errors reported by paediatric emergency providers in a global paediatric emergency care research network.

May 10, 2023

A critical appraisal of AHRQ's "Diagnostic Errors" report.

May 10, 2023

Listen to the whispers before they become screams: addressing Black maternal morbidity and mortality in the United States.

May 3, 2023

Annual Perspective

Improving Diagnostic Safety and Quality

April 26, 2023

Diagnostic error among vulnerable populations presenting to the emergency department with cardiovascular and cerebrovascular or neurological symptoms: a systematic review.

April 26, 2023

Crisis scenarios for simulation-based nontechnical skills training for cardiac surgery teams: a national survey among cardiac anesthesiologists, cardiac surgeons, clinical perfusionists, and cardiac operating room nurses.

April 12, 2023

Managing interruptions to improve diagnostic decision-making: strategies and recommended research agenda.

March 29, 2023

Crowding in the Emergency Department: Challenges for the Care of Children.

March 15, 2023

The role of bias in clinical decision-making of people with serious mental illness and medical co-morbidities: a scoping review.

February 22, 2023

Misdiagnosis in the emergency department: time for a system solution.

February 8, 2023

The woman who cried pain: do sex-based disparities still exist in the experience and treatment of pain?

February 8, 2023

Assessing experiences of racism among Black and White patients in the emergency department.

January 25, 2023

ER doctors misdiagnose patients with unusual symptoms.

January 18, 2023

Diagnostic Errors in the Emergency Department: A Systematic Review.

December 21, 2022

Perspectives of emergency clinicians about medical errors resulting in patient harm or malpractice litigation.

November 30, 2022

Affective influences on clinical reasoning and diagnosis: insights from social psychology and new research opportunities.

October 19, 2022

Emergency department adverse events detected using the emergency department trigger tool.

August 24, 2022

Stigma and healthcare access among transgender and gender-diverse people: a qualitative meta-synthesis.

July 20, 2022

Safety-II and the study of healthcare safety routines: two paths forward for research.

July 13, 2022

What can we learn from in-depth analysis of human errors resulting in diagnostic errors in the emergency department: an analysis of serious adverse event reports.

May 18, 2022

April 27, 2022

The effect of clinician feedback interventions on opioid prescribing.

April 27, 2022

Discrepancy between emergency department admission diagnosis and hospital discharge diagnosis and its impact on length of stay, up-triage to the intensive care unit, and mortality.

February 16, 2022

Impact of teamwork and communication training interventions on safety culture and patient safety in emergency departments: a systematic review.

January 26, 2022

Antecedent treat-and-release diagnoses prior to sepsis hospitalization among adult emergency department patients: a look-back analysis employing insurance claims data using Symptom-Disease Pair Analysis of Diagnostic Error (SPADE) methodology.

December 8, 2021

See More About The Topic

Researchers

Emergency Departments

Educators

Emergency Medicine

Pediatric Emergency Medicine

Misdiagnosis and failure to diagnose in emergency care: causes and empathy as a solution.

Connect With Us

Sign up for Email Updates

Agency for Healthcare Research and Quality

Misdiagnosis and failure to diagnose in emergency care: causes and empathy as a solution.

Connect With Us

Sign up for Email Updates

Agency for Healthcare Research and Quality

Submit Your Innovations

Continue as a Guest

Continue Logged In

Submit Your Innovations

Continue as a Guest

Continue logged in

New Users to the PSNet site