DIAGNOSTIC ERROR AT THE EMERGENCY DEPARTMENT — MEDICAL IMAGING INTERFACE: AN AUSTRALASIAN SURVEY

Monday, October 24, 2011
Poster Board # 3
(Scientific Abstracts should report the results of original research related to diagnostic error in medicine and must contain quantitative or qualitative data. Each abstract should be 400 words or less, have a descriptive title, and the following 4 sections: background, methods, results, and conclusion; may include 1 table or figure. ) Scientific Abstract

Carmel C. Crock, FACEM, Royal Victorian Eye and Ear Hospital, Melbourne, Australia, D. Neil Jones, FRANZCR, Flinders Medical Centre,, Adelaide, Australia, Gordon Schiff, MD, Brigham and Women's Hospital, Boston, MA, William B. Runciman, Australian Patient Safety Foundation, Adelaide, Australia, John Slavotinek, Flinders Medical Centre, Adelaide, Australia and Melissa Baysari, Australian Institute of Health Innovation, University of New South Wales, Sydney, Australia

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.