Diagnostic errors in an accident and emergency department

TLDR

The study aimed to describe diagnostic errors in a busy district general hospital A&E department over four years and to recommend that junior doctors receive specific radiograph‑interpretation training before working unsupervised. Over four years, 953 diagnostic errors were recorded in 934 patients, 79.7 % were missed fractures, most due to misreading radiographs (77.8 %) or failure to perform radiography (13.4 %), predominantly committed by SHOs, resulting in 22 complaints/legal actions, 3 deaths, and showing that missed abnormalities were generally not difficult to diagnose.

Abstract

To describe the diagnostic errors occurring in a busy district general hospital accident and emergency (A&E) department over four years.All diagnostic errors discovered by or notified to one A&E consultant were noted on a computerised database.953 diagnostic errors were noted in 934 patients. Altogether 79.7% were missed fractures. The most common reasons for error were misreading radiographs (77.8%) and failure to perform radiography (13.4%). The majority of errors were made by SHOs. Twenty two diagnostic errors resulted in complaints and legal actions and three patients who had a diagnostic error made, later died.Good clinical skills are essential. Most abnormalities missed on radiograph were not difficult to diagnose. Junior doctors in A&E should receive specific training and be tested on their ability to interpret radiographs correctly before being allowed to work unsupervised.