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Diagnostic errors related to acute abdominal pain in the emergency department
  1. Laura Medford-Davis1,
  2. Elizabeth Park2,
  3. Gil Shlamovitz3,
  4. James Suliburk4,
  5. Ashley ND Meyer5,
  6. Hardeep Singh5
  1. 1Department of Emergency Medicine, Robert Wood Johnson Foundation Clinical Scholars, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  2. 2Section of Emergency Medicine, Baylor College of Medicine and Harris Health System, Ben Taub General Hospital Emergency Center, Houston, Texas, USA
  3. 3Department of Emergency Medicine, University of Southern California Keck School of Medicine, Los Angeles, California, USA
  4. 4Michael E DeBakey Department of Surgery, Baylor College of Medicine and Harris Health System, Houston, Texas, USA
  5. 5Houston Veterans Affairs Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas, USA
  1. Correspondence to Dr Laura Medford-Davis, Robert Wood Johnson Foundation Clinical Scholars, Department of Emergency Medicine, University of Pennsylvania, 1310 Blockley Hall 423 Guardian Drive, Philadelphia, PA 19104-6021, USA; medford.davis{at}gmail.com

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.

  • errors
  • quality assurance
  • abdomen- non trauma
  • safety
  • diagnosis

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