Errors!

January 7th, 2023| Topic: RaMbLeS | 2

According to the CDC, about 136 million folks go emergency rooms (ERs) in the USA each year. That’s about 373,000 a day, 15,525 every hour, 259 every minute, 4 every second. All day, all night, all week, all year. Every year!

Overall ERs are good places to visit when you are in an emergency. But according a to a systematic review from Agency for Healthcare Research and Quality, approximately 5.7% are misdiagnosed: 21,260 misdiagnosed patients every day! Wow!

Of course, not all of them suffer an adverse event as a result. Only 2%. Hey, but that’s still about 7,500 a day! And some of these adverse events are serious, about 0.3%. And that is 1,110 patients a day!

This translates to about 1 in 18 ED patients receiving an incorrect diagnosis, 1 in 50 suffering an adverse event, and 1 in 350 suffering permanent disability or death.”

Although overall error and harm rates are derived from three smaller studies conducted outside the United States (in Canada, Spain, and Switzerland, with combined n=1,758), study methods were prospective and rigorous. All three were conducted at university hospitals, and, for the two studies used to estimate harms, about 92 percent of clinicians under study at those institutions had full training or formal certification in emergency medicine. So it wasn’t a quack making blunders here.

If you have one of these five conditions—stroke, myocardial infarction, aortic aneurysm/dissection, spinal cord compression/injury, venous thromboembolism—you have a disease falling into the 39% of serious misdiagnosis-related harms.

Stroke, the top serious harm-producing disease, is missed an estimated 17% of the time, about 1 in every 5. And the younger you are, the more chance your stroke is missed. It is worse if you are female and non-White.

Root causes of ER diagnostic errors were mostly cognitive errors linked to the process of bedside diagnosis. Malpractice claims associated with serious misdiagnosis-related harms involved failures of clinical assessment, reasoning, or decision making in about 90 percent of cases. Similar findings were seen in incident report data.”

Cognitive errors!

The fact is that that the error rates are comparable to those found in primary care and other clinical settings. It isn’t the case that ER docs are more prone to error. We all are (even dermatologists!). But the number of patients potentially impacted is large in the case of ERs, simply because of the vast numbers of people go through them.

But, be encouraged, God—he doesn’t make mistakes:

The [only] God—His path is blameless;
the utterance of Yahweh is proven;
He is a shield to all who take refuge in Him.
Psalm 18:30

And notice what he does for us: He is …

… the God who girds me with strength
and makes my path blameless.
Psalm 18:32

The blameless God helps me become blameless before him!

And there’s more:

He makes my feet like deers’,
and upon my high places stations me.
You give me the shield of Your deliverance,
and Your right hand upholds me;
and Your response makes me great.
You broaden my steps under me,
and my ankles do not give way.
Psalm 18:33, 35–36

Only one response to this blameless, perfect non-mistake-making God:

I love You, Yahweh, my strength.
Yahweh is my rock and my steadfastness and the One who saves me,
my God, my cliff, I take refuge in Him;
my shield and the horn of my deliverance, my haven. …
Therefore I will give thanks to You among the nations, Yahweh,
and to Your name I will sing praises!
Psalm 18:1–2, 49

SOURCE: Agency for Healthcare Research and Quality