The Drive Home

Christopher Beach, MD, FACEP
Chair, ACEP’s Quality Improvement and Patient Safety Section


Beach2014Diagnostic error is a recent common buzzword in healthcare, catching the attention of healthcare providers, media and laypersons alike.  We’ve all seen articles with conclusions or commentary such as:

“…we estimate 15,000-165,000 misdiagnosed cerebrovascular events annually in US ED’s…”1

“…diagnostic error is the leading cause of medical malpractice claims in the US, and is estimated to cause 40,000 – 80,000 deaths annually.”2

“…Americans' health is even worse than we thought, ranking below 16 other developed nations.”3

So it’s nice to see the recent press release from the U.S. Department of Health and Human Services (HHS) that revealed improvements in safety of care based predominantly on reductions in pharmaceutical errors, falls and infections.  Since most patients begin their inpatient hospital visit in the ED we should be proud that we are a part of a reduction in hospital acquired conditions such as ventilator associated pneumonia, falls, pressure ulcers and venous thromboembolic complications, amongst others. So it reads:

“…estimated to have prevented nearly 15,000 deaths in hospitals, and saved $4.1 billion in costs, and prevented 560,000 patient harms in 2011 and 2012.”4

Most of us finish a shift proud and satisfied for helping people in the ED with their acute (or chronic) medical conditions.  We recall these same people as we drive home, contemplating medical decisions made or interactions with providers or patients.  Humans are fallible and, therefore, diagnostic error will always have its place on the list of opportunities for quality and safety improvement.  The system is designed (whether intentionally or not) with the ED as the diagnostic hub for much of healthcare.  That very same contemplative emergency physician who drives home reviewing the numerous care decisions they’ve made is also impacting efforts to reduce diagnostic error.  Although it’s unlikely anyone will quantify or publish these contributions to reducing diagnostic error, I want to thank you and recognize you for these individual reflections that do result in more accurate diagnoses.  It’s these little things that contribute to:

“…a substantial 9 percent decrease in harms experienced by patients in hospitals.”4

 

  1. Newman-Toker DE, et al. Missed diagnosis of stroke in the emergency department: a cross-sectional analysis of a large population-based sample. Diagnosis. ISSN (Online) 2194-802X, ISSN 2194-8011, DOI: 10.1515/dx-2013-0038, April 2014.
  2. Society to Improve Diagnosis in Medicine. http://www.improvediagnosis.org Accessed May 18, 2014.
  3. New Health Rankings: Of 17 Nations, U.S. Is Dead Last. The Atlantic.com. January 10, 2013. Accessed at: http://www.theatlantic.com/health/archive/2013/01/new-health-rankings-of-17-nations-us-is-dead-last/267045/
  4. New HHS Data Shows Major Strides Made in Patient Safety, Leading to Improved Care and Savings. Department of Health and Human Services Press Release. May 7, 2014.

 

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