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Diagnostic Error in EM – Pushback on the AHRQ

March 8, 2023

Written by Rebecca White

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Diagnostic errors in the ED occur at rates similar to those in other clinical settings. Not all errors have human causes, and not all are inevitable – this article suggests systems-level opportunities for improvement.

Why does this matter?
A recent review published ED diagnostic error rates. While physicians often view these statistics as personal failures, this article advocates that they are signs the system needs improving. So, where do we start?

To err is human, but there’s more to the story…
The recent systematic review commissioned by the Agency for Healthcare Research and Quality (AHRQ) reported an ED diagnostic error rate of 5.7%, misdiagnosis-related harm rate of 2.0%, and serious misdiagnosis-related harm rate of 0.3%.

In response to the data, this article provides several insights.

Diagnostic errors are pervasive in all areas of healthcare. Comparatively, primary care shows 6.3% and 0.1% rates of diagnostic error and serious harms; there is 8% diagnostic error rate in autopsies and 0.4% serious harms rate in hospitalized patients. Given the challenges of ED practice (cognitive burden, time pressures, performance metrics), it is a testament to the capability of EM physicians that these rates are not higher.

The “Big Three” conditions noted in the AHRQ review (vascular events, infections, cancer) comprise 68% of errors resulting in serious harm and should therefore be the focus of training and quality improvement strategies. Standardized metrics, definitions and practical assessment tools should be developed to increase transparency surrounding errors and accurately monitor occurrence rates. Technological advancements can offer real-time checklists and cognitive aids to clinicians to correct and prevent errors in a “blame-free” fashion.

Misdiagnosis in the Emergency Department: Time for a System Solution. JAMA. 2023 Jan 27. doi: 10.1001/jama.2023.0577. Online ahead of print.

What are your thoughts?