AHRQ's 2022 report Diagnostic Errors in the Emergency Department: A Systematic Review, which reported an estimated 7.4 million patients receive a misdiagnosis in the emergency department every year, garnered public, practitioner, and researcher attention. In this peer-reviewed commentary, the authors critique several components of the report. They also support AHRQ's recommended next steps, and further call for additional public and private funding opportunities to continue improving diagnostic accuracy in the emergency department.

Near-miss incidents present useful learning opportunities but frequently go unreported. This study used a computerized trigger tool to identify near-miss incidents in the emergency department (ED). Results show approximately 23% of ED visits during the 13-month study period included a near-miss incident. This analysis suggests computerized trigger tools can be useful to identify near misses that otherwise go unreported.

Trigger tools are a novel method of detecting adverse events. This article describes the location, severity, omission/commission, and type of adverse events retrospectively detected using the computerized Emergency Department Trigger Tool (EDTT). Understanding the characteristics of prior adverse events can guide future quality and safety improvement efforts.

This study assessed the performance of an automated emergency department (ED) trigger tool designed to identify a more efficient sample of adverse event cases for chart review. Beginning with a set of 97 candidate triggers, researchers identified those triggers associated with adverse events and arrived at a narrowed set of 30 triggers, eliminating almost half of the population of records eligible for manual review. This computerized query may eliminate the need for manual screening for triggers.  

Trigger tools are one approach to identifying adverse events. This retrospective cohort study developed an emergency department (ED) trigger tool to characterize adverse events that are present on arrival (POA). The majority (60.8%) of adverse events identified in the ED were POA, accounting for an estimated 7.6% of ED visits. The most comment POA adverse events were medication-related (55.6%).

Emergency department crowding is linked to medication errors and other preventable harm. Crowding requires providers to evaluate patients quickly under suboptimal conditions, such as in hallways or waiting rooms with inadequate nursing support, which may lead to diagnostic errors. This cross-sectional survey of emergency medicine physicians assessed how evaluating patients in the hallway or with a companion present changed their usual diagnostic practices. Researchers found that 90% of physicians altered their history-taking or physical examination, and 40% reported a diagnostic error or delay as a result. The most common missed diagnoses were suicidal ideation, abuse or neglect, and genitourinary system disease. A PSNet Perspective and a WebM&M commentary discussed strategies to reduce diagnostic errors in emergency departments.

… J Patient Saf … J Patient Saf … Measuring adverse events and near misses …

… J Patient Saf … Researchers sought to develop an …

Many emergency departments (EDs) have recently implemented electronic medical records (EMRs) specifically designed for emergency care. This article evaluates the benefits and potential threats to patient safety of various emergency department information systems (EDISs). Case studies illustrate patient safety pitfalls of inferior EDIS products or of improper implementation. The authors propose seven recommendations for appropriate and safe EDIS deployment, including ED physician engagement, risk transparency from vendors and clients, and a call for legal responsibility from vendors. An AHRQ WebM&M commentary discusses a patient who received an extra dose of vancomycin due to inadequate communication between the EDIS and the hospital EMR.

Computerized reminders to renew orders for physical restraints were combined with a forcing function—denial of computer access until the order was completed—in this trial conducted in an emergency department. Although clinician ordering behavior improved, no significant improvement was found in the amount of time patients spent in restraints.

This study found that other health care providers were a relatively frequent source of complaints for the emergency department, and the issues they raised could be used to identify opportunities to improve quality and safety.

This study addressing the causes of missed and delayed diagnoses in emergency department patients used similar methodology as a companion study of error in the ambulatory setting and a prior study of surgical patients. Errors involved a broad range of patients and conditions. As in the outpatient arena, errors generally occurred due to failure to order diagnostic tests or interpret them correctly; factors contributing to error included cognitive factors (ie, physician judgment or knowledge), but system factors (ie, fatigue or communication breakdowns) were involved in a significant proportion of cases. As was also found in the study of ambulatory patients, the multifactorial nature of the errors identifies many potential areas for action but likely defies simple solutions.