Understanding human causes of diagnostic errors can lead to more specific targeted, specific recommendations and interventions. Using three classification instruments, researchers examined a series of serious adverse events related to diagnostic errors in the emergency department. Most of the human errors were based on intended actions and could be classified as mistakes or violations. Errors were more frequently made during the assessment and testing phases of the diagnostic process.
Brommelsiek M, Said T, Gray M, et al. Am J Surg. 2021;221:980-986.
Silence in the operating room (OR) can have implications on surgical team function and patient safety. Through interviews with interprofessional surgical team members, the authors explored the influence of silence on team action in the OR and found that silence in the surgical environment – whether due to team cohesion or individual defiance – has implications for team functions.
Pelaccia T, Messman AM, Kline JA. Patient Edu Couns. 2020;103:1650-1656.
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.
Fasano HT, McCarter MSJ, Simonis JM, et al. Simul Healthc. 2021;6:85-91.
This study explored disparities in physician decision making among patients of varying socioeconomic status (SES) during simulated scenarios. While quantitative analyses did not identify a significant relationship between SES and image or medication ordering, patient-perceived empathy, or clinical performance, qualitative analyses identified three themes which may bias decision making – overt diagnostic focus, discharge planning, and risk and exposure.
Fortman E, Hettinger AZ, Howe JL, et al. J Am Med Inform Asso. 2020.
Physicians from different health systems using two computerized provider order entry (CPOE) systems participated in simulated patient scenarios using eye movement recordings to determine whether the physician looked at patient-identifying information when placing orders. The rate of patient identification overall was 62%, but the rate varied by CPOE system. An expert panel identified three potential reasons for this variation – visual clutter and information density, the number of charts open at any given time, and the importance placed on patient identification verification by institutions.
Plint AC, Stang A, Newton AS, et al. BMJ Qual Saf. 2021;30:216-227.
This article describes emergency department (ED)-related adverse events in pediatric patients presenting to the ED at a pediatric hospital in Canada over a one-year period. Among 1,319 patients at 3-months follow-up, 33 patients (2.5%) reported an adverse event related to their ED care. The majority of these events (88%) were preventable. Most of the events involved diagnostic (45.5%) or management issues (51.5%) and resulted in symptoms lasting more than one day (72.7%).
Isbell LM, Boudreaux ED, Chimowitz H, et al. BMJ Qual Saf. 2020;29:815–825.
Research has suggested that health care providers’ emotions may impact patient safety. These authors conducted 86 semi-structured interviews with emergency department (ED) nurses and physicians to better understand their emotional triggers, beliefs about emotional influences on patient safety, and emotional management strategies. Patients often triggered both positive and negative emotions; hospital- or systems-level factors primarily triggered negative emotions. Providers were aware that negative emotions can adversely impact clinical decision-making and place patients at risk; future research should explore whether emotional regulation strategies can mitigate these safety risks.
Much of the evidence about preventable harm in patients with psychiatric illnesses is limited to inpatient psychiatric facilities. This case-control study explores patient-related factors that place patients at an increased risk for patient safety incidents in primary or emergency care. While differences in income, education, and foreign background had some association with preventable harm, researchers found that psychiatric illness nearly doubled the risk of preventable harm among both emergency and primary care patients, with nearly half (46%) of harm attributable to diagnostic errors.
Isbell LM, Tager J, Beals K, et al. BMJ Qual Saf. 2020;29:803-814.
Providers’emotional state can affect clinical decision-making and patient safety. In this study, ED nurses and physicians recalled three patient experiences (an angry encounter, a positive encounter and a mental health encounter) and rated their emotions and engagement in the encounters and their perception of how their emotions impacted their decisions and behavior. Perceived patient safety risks were higher during angry and mental health encounters positive encounters were associated with perceptions of higher quality care. These findings highlight the importance of educating clinicians about emotional influences and how to manage them as well as the need for research to explore evidence-based interventions to mitigate emotion-induced patient safety risks.
Appelbaum N, Clarke J, Feather C, et al. BMJ Open. 2019;9:e032686.
While medication errors during paediatric resuscitation are considered common, little information about the processes that contribute to them has been gathered. This prospective observational study in a large English teaching hospital describes the incidence, nature and severity of medication errors made by 15 teams, each comprised of two doctors and two nurses, during simulated paediatric resuscitations. Clinically significant errors were made in 11 of the 15 cases, most due to discrepancies in drug ordering, preparation and administration. The authors recommend additional research into new approaches to protecting patients in paediatric emergency settings.
Schnapp BH, Sun JE, Kim JL, et al. Diagnosis (Berl). 2018;5:135-142.
In 2015, the National Academy of Medicine called for renewed focus on reducing diagnostic error. Among patients admitted to the hospital shortly after discharge home from the emergency department, researchers found that 19% of cases involved a cognitive error, such as faulty information processing or inaccurate data verification, which may contribute to diagnostic errors.
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