Epidemiology of Medical Adverse Events in Emergency Department
Date Issued
2006
Date
2006
Author(s)
Shih, Chung-Liang
DOI
zh-TW
Abstract
Background: Recent evidence from several epidemiology studies on medical error revealed that many patients are harmed rather than helped when encountering the healthcare system. Patient safety has become a significant public health issue since the beginning of the 21st century. Although there are many attempts to improve safety in health care, the most important aspect is to identify and eliminate risks and hazards that can cause or have the potential to cause healthcare-associated injuries. Despite of a recent published study implicating that emergency department (ED) is a key environment for preventable medical errors, there are only a few data in literature about medical injuries in emergency medicine.
Objective: The aim of this research is to estimate the incidence of adverse events happened in the ED and further identify preventable and potential adverse events by using a two-phase chart review.
Methods: We reviewed 11,382 randomly selected medical records from the ED of a tertiary teaching hospital in the year 2002. The first stage is a screening process done by nurses involving several criteria consisting of readily identifiable events or quality indicators associating with poor patient outcome. The secondary stage is detailed analysis of medical records positive for one of the screening criteria done by ED physicians. Randomized controls were selected and also examined by physicians. Each record is examined using a structured adverse event analysis form. Reliability and validity of this two-phase chart review process is also performed. Finally, these adverse events and their relation to error, negligence, and risk factors are analyzed and reported.
Results: Adverse events occurred in 2% of patients visiting the emergency department (95% confidence interval, 1.6 to 2.4), and 37% of adverse events were considered to be highly preventable by researchers. Although most of the adverse events result in no harm or minimal injuries, 18% did cause obvious injuries to patients. “Missed or delayed diagnosis” was the most common type of adverse events, followed by “inadequate management or monitoring” and “incomplete assessment”. The probability of adverse events was highest for old age (>65 years), longer stays in ED, multiple comorbidities, and those hospitalized or died in ED. Among screening criterias used in first stage of chart review, the indicators most related to adverse events, including “unscheduled return to ED within 72 hours”, “medical litigation happened in ED”, “length of stay in ED over 24 hours”, “readmission within 7 days after ED visit”, and “discrepancy between initial and final diagnosis in ED”. Team work and personal factor were identified to be the most important to errors.
Conclusions: The results of this study showed that there is a substantial amount of adverse events happened to patients in ED mostly due to medical management errors. Reducing the incidence of adverse events will require identifying their characteristics in epidemiology and developing methods to prevent errors or reduce the effects. Further population-based study may be necessary to address these adverse events thereby improving patient care in the ED.
Subjects
醫療不良事件
急診醫學
病人安全
流行病學
medical adverse event
emergency medicine
patient safety
epidemiology
SDGs
Type
thesis
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