BACKGROUND Diagnostic error occurs more frequently in the emergency department than in regular in-patient hospital care. We sought to characterise the nature of reported diagnostic error in hospital emergency departments in England and Wales from 2013 to 2015 and to identify the priority areas for intervention to reduce their occurrence. METHODS A cross-sectional mixed-methods design using an exploratory descriptive analysis and thematic analysis of patient safety incident reports. Primary data were extracted from a national database of patient safety incidents. Reports were filtered for emergency department settings, diagnostic error (as classified by the reporter), from 2013 to 2015. These were analysed for the chain of events, contributory factors and harm outcomes. RESULTS There were 2288 cases of confirmed diagnostic error: 1973 (86%) delayed and 315 (14%) wrong diagnoses. One in seven incidents were reported to have severe harm or death. Fractures were the most common condition (44%), with cervical-spine and neck of femur the most frequent types. Other common conditions included myocardial infarctions (7%) and intracranial bleeds (6%). Incidents involving both delayed and wrong diagnoses were associated with insufficient assessment, misinterpretation of diagnostic investigations and failure to order investigations. Contributory factors were predominantly human factors, including staff mistakes, healthcare professionals' inadequate skillset or knowledge and not following protocols. CONCLUSIONS Systems modifications are needed that provide clinicians with better support in performing patient assessment and investigation interpretation. Interventions to reduce diagnostic error need to be evaluated in the emergency department setting, and could include standardised checklists, structured reporting and technological investigation improvements.

中文翻译：

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急诊科的诊断错误：从全国患者安全事件报告分析中吸取教训。


背景诊断错误在急诊室比在常规住院护理中更容易发生。我们试图描述 2013 年至 2015 年英格兰和威尔士医院急诊科报告的诊断错误的性质，并确定干预的优先领域，以减少其发生。方法 采用横断面混合方法设计，对患者安全事件报告进行探索性描述性分析和主题分析。主要数据是从国家患者安全事件数据库中提取的。 2013 年至 2015 年的报告针对急诊科设置、诊断错误（按记者分类）进行了筛选。对这些报告进行了事件链、影响因素和伤害结果的分析。结果 确诊错误诊断2288例，其中延误诊断1973例（86%），错误诊断315例（14%）。据报道，七分之一的事件造成严重伤害或死亡。骨折是最常见的情况（44%），其中颈椎骨折和股骨颈骨折是最常见的类型。其他常见病症包括心肌梗塞（7%）和颅内出血（6%）。涉及延迟诊断和错误诊断的事件与评估不足、诊断调查的误解和未能下令调查有关。促成因素主要是人为因素，包括工作人员失误、医疗保健专业人员技能或知识不足以及不遵守协议。结论 需要对系统进行修改，以便为临床医生进行患者评估和调查解释提供更好的支持。 减少诊断错误的干预措施需要在急诊科环境中进行评估，可能包括标准化检查表、结构化报告和技术调查改进。