Background: Diagnostic error is a significant cause of patient harm in the emergency department (ED). Since medical imaging is often integral to diagnosis, many of the diagnostic errors that occur in the ED involve medical imaging. We surveyed emergency physicians and radiologists to determine the types of diagnostic error related to imaging that occur in the ED, the causes of these errors, their clinical impact and potential preventative strategies.
Methods: A nine-item, online survey was sent to emergency physicians and radiologists throughout Australia and New Zealand. Respondents were asked to describe two cases of diagnostic error involving the ED-medical imaging interface that they had observed or in which they had been involved, including contributing factors, clinical impact and frequency of the error. Respondents categorized the error according to the error classification system proposed by Runciman (2007). Respondents were asked to suggest how the diagnostic error could have been prevented.
Results: 288 diagnostic errors were reported and analysed. The most common misdiagnoses reported in this survey were cervical spine fracture, pneumothorax, pneumonia, metastases and perforated viscus. The most frequently reported error types were error in perception, error in acquisition of knowledge and error in matching. In about one third of cases, a violation was thought to contribute to the diagnostic error. Most errors reported were committed by a clinician other than the clinician who submitted the survey (>70%). The clinical impact of the error was moderate or major in over 5O% of reported errors. Interprofessional attitudes and communication failures between the two specialties arose as significant contributing factors. Preventive strategies identified included real-time reporting of images by radiologists, improved after hours staffing and supervision and more robust discrepancy management.
Conclusion: The interface between the ED and medical imaging offers a useful window to explore diagnostic error. A closer examination of this interface may yield insights into the nature of diagnostic error in general, including causes and prevention. Our study suggests that improving communication between key specialties has the potential to decrease diagnostic error.
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