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ACEP Now: Vol 42 – No 02 – February 2023
Adapted from: Newman-Toker et al. Diagnostic Errors in the Emergency Department: A Systematic Review. 2022. Data on these conditions were drawn from several studies in the systematic review.
Table 3: The 10 most common “root causes” identified in ED malpractice litigation (in rank order)
- Thinking problems (i.e. clinical judgment)
- Issues with communication
- Issues related to documentation
- Issues related to lack of insurance
- Clinical environment
- Behavior-related
- Administrative issues
- Supervision issues
- Technical skill
- Electronic health records
Adapted from: Newman-Toker et al. Diagnostic Errors in the Emergency Department: A Systematic Review. 2022. Data were drawn from a large database of emergency medicine malpractice claims.
Jesse M. Pines, MD, MBA, MSCE is the National Director of Clinical Innovation at US Acute Care Solutions. and a Professor of Emergency Medicine at Drexel University.
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2 Responses to “The AHRQ Diagnostic Errors Study: A Peer Reviewer’s Reaction”
January 27, 2023
David L Meyers, MD, MBE, FACEPWell, the more I read the responses of ACEP and other EM-associated organizations to the AHRQ/Hopkins study, the more embarrassed I am for emergency medicine. Even acknowledging the flaws of the study, the defensive nature of many of those responses and the criticism of the messengers are what one might expect from the troglodytes at the AMA, not from our organization, that purports to have patient well-being and advocacy for them as a major focus.
In the interest of transparency, David Newman-Toker, one of the lead authors on the study, is a friend of mine as well as a former colleague on the board of the Society to Improve Diagnosis in Medicine. He and I have discussed the study on more than one occasion, and I conveyed to him that ACEP’s and patients’ interests would have been much better served by an acknowledgement of the magnitude of the problem of the frequency and severity of diagnostic errors and the associated harm in the course of emergency care, a description of what ACEP and others have been doing to address the problem, our successes and our continuing focus on doing better.
A more reasoned response, like the one just published in JAMA (https://jamanetwork.com/journals/jama/fullarticle/2801049?guestAccessKey=3627c246-c83c-4d31-966f-0d6342f0a69e&utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-jama&utm_content=olf&utm_term=012723) would have been so much more responsible and helpful. What ACEP and its partners in this matter have done has only deepened animosity toward medicine and doctors while accomplishing nothing to improve diagnosis.
I think ACEP is on the wrong side of history in this matter, and I can’t imagine that patients and families, so many of whom have stories about their own personal diagnostic misadventures in the ER (I do; do you?), will find the position of the College and its co-signers credible let alone admirable.
February 3, 2023
Bobby RedwoodThank you Dr. Pines for your thoughtful review of the article, your explanation on the review process, and your high-yield pearls on diagnostic error in the ED.
Don’t worry, we still love you:)