Skip to main content Accessibility help
×
×
Home

Errors, near misses and adverse events in the emergency department: What can patients tell us?

  • Steven M. Friedman (a1), David Provan (a1), Shannon Moore (a1) and Kate Hanneman (a1)
Abstract
Objective:

We sought to determine whether patients or their families could identify adverse events in the emergency department (ED), to characterize patient reports of errors and to compare patient reports to events recorded by health care providers.

Methods:

This was a prospective cohort study in a quaternary care inner city teaching hospital with approximately 40 000 annual visits. ED patients were recruited for participation in a standardized interview within 24 hours of ED discharge and a follow-up interview 3–7 days after discharge. Responses regarding events were tabulated and compared with physician and nurse notations in the medical record and hospital event reporting system.

Results:

Of 292 eligible patients, 201 (69%) were interviewed within 24 hours of ED discharge, and 143 (71% of interviewees) underwent a follow-up interview 3–7 days after discharge. Interviewees did not differ from the base ED population in terms of age, sex or language. Analysis of patient interviews identified 10 adverse events (5% incident rate; 95% confidence interval [CI] 2.41%–8.96%), 8 near misses (4% incident rate; 95% CI 1.73%–7.69%) and no medical errors. Of the 10 adverse events, 6 (60%) were characterized as preventable (2 raters; κ = 0.78, standard error [SE] 0.20; 95% CI 0.39–1.00; p = 0.01). Adverse events were primarily related to delayed or inadequate analgesia. Only 4 out of 8 (50%) near misses were intercepted by hospital personnel. The secondary interview elicited 2 out of 10 adverse events and 3 out of 8 near misses that had not been identified in the primary interview. No designation (0 out of 10) of an adverse event was recorded in the ED medical record or in the confidential hospital event reporting system.

Conclusion:

ED patients can identify adverse events affecting their care. Moreover, many of these events are not recorded in the medical record. Engaging patients and their family members in identification of errors may enhance patient safety.

    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Errors, near misses and adverse events in the emergency department: What can patients tell us?
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Errors, near misses and adverse events in the emergency department: What can patients tell us?
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Errors, near misses and adverse events in the emergency department: What can patients tell us?
      Available formats
      ×
Copyright
Corresponding author
Toronto General Hospital, 200 Elizabeth St., Toronto ON M5G 2C4; steven.friedman@utoronto.ca
References
Hide All
1.Adams, JG, Bohan, JS. System contributions to error. Acad Emerg Med 2000;7:1189–93.
2.Weingart, SN, Pagovich, O, Sands, DZ, et al.What can hospitalized patients tell us about adverse events? J Gen Intern Med 2005;20:830–6.
3.Forster, AJ, Murff, HJ, Peterson, JF, et al.The incidence and severity of adverse events affectingpatients following discharge from the hospital. Ann Intern Med 2003;138:161–7.
4.Forster, AJ, Clark, HD, Menard, A, et al.Adverse events affecting medical patients following discharge from hospital. CMAJ 2004;170:345–9.
5.Burroughs, TE, Waterman, AD, Gallagher, TH, et al.Patient concerns about medical errors in emergency departments. Acad Emerg Med 2005;12:5764.
6.Forster, AJ, Rose, NGW, Walraven, CV, et al.Adverse events following an emergency department visit. Qual Saf Health Care 2007;16:1722.
7.Gandhi, TK, Weingart, SN, Peterson, J, et al.Adverse drug events in ambulatory care. N Engl J Med 2003;348:1556–64.
8.Joint Commission for Accreditation of Healthcare Organizations. Comprehensive accreditation manual for hospitals: the official handbook. Joint Commission Accreditation Healthcare Organizations. Oakbrook Terrace (IL): The Organization; 2006.
9.Pines, JM, Hollander, JE. Emergency department crowding is associated with poor care for patients with severe pain [discussion 6-7]. Ann Emerg Med 2008;51:15.
10.Leape, LL. Error in medicine. JAMA 1994;272:1851–7.
11.Cullen, DJ, Bates, DW, Small, SD, et al.The incident reporting system does not detect adverse drug events: a problem for quality improvement. JT Comm J Qual Improv 1995;21:541–52.
12.Taylor, JA, Brownstein, D, Christakis, DA, et al.Use of incident reports by physicians and nursesto document medical errors in pediatric patients. Pediatrics 2004;114:729–35.
13.Fordyce, J, Blank, FSJ, Pekow, P, et al.Errors in a busy emergency department. Ann Emerg Med 2003;42:324–33.
14.Vincent, C, Stanhope, N, Crowley-Murphy, M. Reasons for not reporting adverse incidents: an empirical study. J Eval Clin Pract 1999;5:1321.
15.Lawton, R, Parker, D. Barriers to incident reporting in a healthcare system. Qual Saf Health Care 2002;11:15–8.
16.Leape, LL. Reporting of adverse events. N Engl J Med 2002;347:1633–8.
17.Khare, RK, Uren, B, Wears, RL. Capturing more emergency department errors via an anonymous web-based reporting system. Qual Manag Health Care 2005;14:91–4.
18.Morey, JC, Simon, R, Jay, GD, et al.Error reduction and performance improvement in the emergency department through formal teamwork training: evaluation results of the MedTeams project. Health Serv Res 2002;37:1553–81.
19.Elinson, R, Friedman, SM. Emergency Physician Time and Motion Study. Acad Emerg Med 2004;11:457-b-458.
20.Wears, RL. A different approach to safety in emergency medicine. Ann Emerg Med 2003;42:334–46.
21.Lyons, M. Should patients have a rolein patient safety? A safety engineering view. Qual Saf Health Care 2007;16:140–2.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Canadian Journal of Emergency Medicine
  • ISSN: -
  • EISSN: 1481-8035
  • URL: /core/journals/canadian-journal-of-emergency-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed