In an effort to reduce emergency room errors and related malpractice claims, some hospitals and liability insurers are looking into resolved claims to see what went wrong and find ways to avoid future medical mistakes.
For example, an Emergency Medicine Leadership Summit sponsored by liability insurer Crico/RMF invited its clients - insured hospitals - to identify the key factors contributing to missed or delayed ER diagnoses. They found that breakdowns in physician-nurse communication often happen at a crucial care stage, leading to emergency room errors. After field-testing strategies to improve communication, these same hospitals compiled a list of systemic changes that hospitals can make to prevent errors, including:
•· Improved teamwork and process improvements
•· Structured communication
•· Ongoing professional development and education
Reliance on Technology, Rather Than Direct Communication, Can Lead to Errors
South Carolina emergency rooms face the same challenges as others across the country. While doctors, like anyone, can simply make mistakes, the Crico/RMF summit found that most errors were simply routine breakdowns in communication that failed to bring necessary information to light. Excessive reliance on electronic communication, for example, can lead to misunderstandings and gaps in information. It can also allow doctors and nurses to make incorrect assumptions about the information others possess.
In one example, an 18-year old with fever and chills came to the ER, a nurse noticed mottled skin - a sign indicating a blood infection - and noted it on the chart. Not reading the note, the doctor discharged the patient with some Tylenol. The next day, the patient returned, was admitted to intensive-care, and died of shock and sepsis.
Chaos and Crowding in the ER is a Contributing Factor
Improvement in reducing emergency room errors will require strong, sustained effort. Other healthcare players, as the National Institutes of Health, will need to be involved.
But reviewing resolved claims is clearly one place to start. Such reviews can help prevent future medical mistakes and help create new approaches to care, according to ER doctors involved in the Crico/RMF summit. However, the doctors also cited a "chaotic and intense atmosphere of increasingly overcrowded emergency departments" as contributing to the problem.
Said Roger Band, an ER physician at the University of Pennsylvania Hospital: "There are tangible things we can fix...but we've outstripped the capacity of the emergency-medicine system in a lot of ways, and we are asked to do a job where it's oftentimes not realistic to be 100 percent perfect."
To be sure, to err is human. Lack of perfection is one thing, however, and outright misdiagnosis is quite another.
