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Emergency room errors caused largely by faulty cognitive processes, study finds

Doctors may have the right information, but may not act on it in the best way.

Jeff Lagasse, Associate Editor

Almost half of medical errors in the emergency room are due to problems with information processing, according to a new study published in De Gruyter's Journal Diagnosis. This issue is not related to technology -- it's a cognitive shortcoming, and accounts for 45 percent of all ER errors.

Care quality in the ER matters, and not just in terms of the patient's health. Consumerism in healthcare is creating an industry in which patients increasingly call the shots, opening up their wallets to hospitals and providers with the best reputations and online ratings. 

Payers also increasingly link reimbursement to quality, creating a financial incentive for hospitals to offer a tip-top experience.

Medical errors are estimated to cause 250,000 deaths per year in the U.S., the report found, and it suggested that errors are due to the way doctors cognitively process the data they have about patients. In other words, doctors have the right information, but might not act on it in the best way.

The emergency department is a very different clinical environment than inpatient wards, with frequent interruptions and often incomplete or unreliable information. Despite this, the study shows that doctors in an emergency department with trainees make similar types of errors to those made with admitted patients -- more information processing errors are made than errors of inadequate knowledge or inadequate information.

Researchers looked at patients who came back to emergency departments a second time within 72 hours and were admitted to the hospital on their second visit, an indicator that care could have been improved during the first visit. A trained team of physicians looked at each case to determine whether the team during the patient's first visit might have made a mistake, and if one was found, determined the type of mistake that was made.

The most frequently identified type of error (45 percent of cases) was a problem with information processing, followed by problems with verifying information that was gathered (31 percent). 

Inadequate knowledge (6 percent) and inadequate information gathering (18 percent) occurred relatively infrequently. Misjudging how significant a finding was and prematurely deciding on an incorrect diagnosis were the individual errors that occurred most frequently (13 percent each).

Lacking in the study was an underlying reason why these cognitive errors occurred, but previous research has shown that physician burnout can negatively impact decision-making and overall care quality.

The study found that patients with abdominal complaints may be particularly vulnerable to these types of errors, through the reason for this remains obscure.

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com

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