Emergency department and Negligence
- 10% of errors are technical errors
- 30% to 55% of errors occur during medical examinations
- 60% of errors are caused by human error
Severity of error
- Small (e.g. a fractured toe)
- Medium (e.g. untreated wound)
- Life threatening (e.g. missed cancer)
Why mistakes are made
- Failures in approach
- Failures in approach to treatments often lead to serious error and can lead to patient being misdiagnosed.
- Bias
- Bias is the ability to hold on to an idea or treatment and disregard any other ideas that are equally valid. This happens due to information shortcuts,
- judgment and memory errors.
- Failures in perception
- Perception is the organization, identification, and interpretation of sensory information; Failures in perception include poor organization tools,
poor identification techniques and miss interpretation of results
Why the emergency department
- High decision density
There are a lot of possible decisions that can be made and its the Doctors job to be able to know which symptoms fit which illness.
- High levels of activity
The emergency department sees the highest levels of activity compared to any other part of the hospital, because of this Serious Illnesses are often over looked.
- Shift work
Nurses and Doctors are on shift work, it can often be very easy for work to become incomplete or misplaced under the fast pace and high work load of the emergency department.
- Poor feedback
Poor feedback from treatments can lead to patient mistreatment and can often be very damaging to the patient.
Making sense
Serious illness can take the form of something else in amongst the coming and going of the emergency department and serious errors are often made. Making sense of the symptoms and giving accurate treatments is essential.
Documentation errors
Documentation errors are errors in documents which lead to the mistreatment or delayed treatment of a patient, Documentation errors include:
- Missing info such as date, time of examination, as well as missing doctors signature/name
- Poor description of the injury or sequence of events
- Poor documentation keeping in regards to past family treatment and history.
Examination errors
Examination errors take place during the patients being seen by their physicians, some common errors are:
- Failure to notice tenderness
- Failure to examine in a co-ordinate manner
- Failure to examine above and below injured area
Diagnosis errors
Diagnosis errors are caused by the physicians:
- Inability to diagnose Diagnoses Delayed
- Inability to consult with senior doctors
- Inability to consider alternative diagnosis
Investigation errors
Investigation errors are the errors associated with the doctors:
- Inability to request proper treatment for patients
- Inability to request blood tests
- Inability to request scans and x-rays
These errors can cause discomfort to the patient and are often life threatening.
Treatment errors
These can often be the most severe type of errors as the wrong treatment can in some cases agitate allergies, have no effect on the patient ,cause unnecessary pain and suffering and in some cases death.
- Misdiagnosed treatments
- The prescription of the wrong medication
- Not treating symptoms while waiting on results of tests
Follow up advice errors
The follow up advice can be very poor or non- existent which leads to many patients suffering from mistreatment. Follow up advice should be clear, confidential and helpful.
Negligence
Negligence is the failure to exercise due care and attention that a professional person in the same circumstances would exercise. negligence in the emergency department is were due care and attention is not paid to every patient, either due to poor training or the number of people doctors see a day. Through law if a person can prove they were treated negligence then they can be awarded compensation for the harm caused to that individual.
Liability
Liability is a current obligation of an individual arising from past actions.in other words its the responsibility of an action caused by an individual in the past that has caused grief or harm to a patient.
Reduce errors
- Training
- Education
It is possible to reduce errors through proper training, partaking in crisis management and risk assessment courses, train physicians to avoid closed loop communication and fixation errors, ensure each physician is trained by innovative teaching (e.g. clinical case analysis) and root cause analysis in individuals, systems and processes.
Summary
Most causes of error in the emergency department are caused by human factors and are almost always preventable through careful examination, proper investigation and efficient management.
Perception is the organization, identification, and interpretation of sensory information; Failures in perception include poor organization tools, poor identification techniques and miss interpretation of results