Diagnostic errors in an accident and emergency department

Accident and Emergency Department, Derriford Hospital, Plymouth PL6 8DH, UK.
Emergency Medicine Journal (Impact Factor: 1.78). 07/2001; 18(4):263-9. DOI: 10.1136/emj.18.4.263
Source: PubMed

ABSTRACT To describe the diagnostic errors occurring in a busy district general hospital accident and emergency (A&E) department over four years.
All diagnostic errors discovered by or notified to one A&E consultant were noted on a computerised database.
953 diagnostic errors were noted in 934 patients. Altogether 79.7% were missed fractures. The most common reasons for error were misreading radiographs (77.8%) and failure to perform radiography (13.4%). The majority of errors were made by SHOs. Twenty two diagnostic errors resulted in complaints and legal actions and three patients who had a diagnostic error made, later died.
Good clinical skills are essential. Most abnormalities missed on radiograph were not difficult to diagnose. Junior doctors in A&E should receive specific training and be tested on their ability to interpret radiographs correctly before being allowed to work unsupervised.

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