Emergency Medicine: Tips to Help Prevent the Top Cause of Patient Injury

The Doctors Company’s Emergency Medicine Closed Claims Study, a review of 332 emergency medicine claims that closed from 2007-2013, revealed that the top patient allegation—accounting for 57 percent of claims—was diagnosis related, including failure to diagnose, delay in diagnosis, and wrong diagnosis. Similarly, the study revealed that the top factor contributing to patient injury (52 percent of claims) was patient assessment issues, such as failure to establish a differential diagnosis and failure to order diagnostic tests.

The top patient allegation and the top contributing factor to patient injury highlight the importance of addressing diagnosis issues in the practice of emergency medicine. Emergency medicine doctors face unique challenges—particularly the challenges of diagnosing patients previously unknown to them, encountering a broad range of clinical problems, and pressures of workflow and workload in a busy emergency room.

These tips can help emergency medicine doctors avoid diagnostic errors:

• Avoid first-impression or intuition-based diagnoses.
• Complete a thorough differential diagnosis for each patient.
• Use diagnostic prompts when completing your differential diagnosis. Because emergency medicine doctors face such a broad range of patients and potential diagnoses, these prompts can help ensure all diagnoses are considered.
• Document your differential diagnosis. This step is especially important to reduce potential liability risks.
• Make sure that all specialists who are called to evaluate emergency department patients receive a comprehensive summary of the clinical picture, including history, physical findings, and diagnostic studies. During the handoff discussion, it should be clear who has responsibility for review and follow-up of all test results and diagnostic studies.
• Practice effective handoffs. Make sure there is interactive communication between physicians when the care of a patient is being handed off so they can determine each physician’s responsibilities. Staff must have a clear understanding of which physician is in charge of the patient’s care.