Blog & Articles

Whether we like it or not, the future of medicine is geriatrics. As the demographics in the United States change in the next 50 years, it is predicted that practitioners will find themselves providing care to a much larger group of elderly patients. For example, the 2014 census data showed that 14.5% of the U.S. population was 65 years of age or older. By 2040, it is estimated that this age group will grow to comprise 22% of the population. People are actually living long enough to form a subgroup of elderly patients who are over 85 years old – the “super-elderly.” This crowd of the super elderly grew three to four times faster than the general population between 1990 and 2010.

Diagnostic error poses a significant threat to patient safety. According to a 2007-2013 closed claims analysis from The Doctors Company, missed or delayed diagnoses are responsible for 57% of malpractice claims in emergency medicine.

Before we can design patient safety initiatives to address diagnostic error in our organizations, we must first understand the breadth of the issue. This infographic outlines the scope of diagnostic error and breakdowns in the diagnostic process that can lead to error.

Tom Syzek, MD, FACEP, served as the Chief Risk Officer of a multi-specialty physician group and President of the group’s captive insurance company. In those roles, he was the focal point for the Communication and Resolution Program (CRP); he attributes many prevented lawsuits to an effective communication and resolution strategy. We picked Tom’s brain to understand some key questions that we hear clients ask about Communication & Resolution Programs.

Pain management in the acute care setting (ED, Urgent Care, office) has once again catapulted to the top of the list of hot topics. Years ago the conversation centered on recognizing pain as a “fifth vital sign” and navigating the tricky crossroad of patient satisfaction and the provision of timely, sufficient pain medication. In the Emergency Department, I witnessed every extreme of practitioner and patient behavior.

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As practitioners, we like to think our charm and skills are so valuable that no patient would possibly consider leaving the ED or hospital against our sage medical advice!

However, no matter how hard we try or how fast we work, a few patients will always choose to leave before an evaluation is complete—and against medical advice (AMA). Available data shows that about 1.2% of ED patients leave AMA.

Acute abdominal pain presents a significant challenge to all healthcare professionals who care for geriatric patients. The signs and symptoms may be atypical, the differential diagnosis is vast, the workup is time-consuming, and the stakes are high. It is estimated that of all elderly patients who present to the emergency department with abdominal pain, as many as 50% will require admission and 30%-40% will require surgery.

The chief complaint of chest pain is common among patients presenting to the office, clinic, urgent care or emergency department. While heart disease is the leading cause of death in the U.S., medical error is the third leading cause. Furthermore, missed or delayed diagnoses are responsible for 57% of malpractice claims in emergency medicine, according to a 2007-2013 closed claims analysis from The Doctors Company.

This infographic outlines common errors in chest pain diagnosis that can lead to an adverse event. Download as a PDF.

The Dangerous Discrepancies

One of the most difficult hurdles to overcome during the defense of a malpractice suit is a significant discrepancy in the medical record. The discrepancies may involve the nurses, physicians, advanced practice clinicians, EMS personnel, and any records related to the patient. Often, a discrepancy may be nothing more than a minor difference in terminology; but the cases reviewed here reveal serious discrepancies between the physician and the nurse chart in the first case and the physician and EMS record in the second case.

Thoracic aortic dissection (TAD) is one of the most dramatic and life-threatening conditions encountered in all of medicine. Every year in the United States, there are an estimated 6,000 to 10,000 cases of TAD. Since it is an uncommon condition compared to the 5 million ED chest pain visits and more than 1 million acute myocardial infarctions, most physicians have diagnosed and treated only a few patients with TAD during their careers.

Ever since the Institute of Medicine’s report To Err is Human was released in 2000, healthcare has seen a surge in patient safety initiatives. Analysis of medical errors has become increasingly widespread, with several different methods being used by hospitals and practitioners. Of these methods, I suggest that cognitive error analysis may prove to be one of the most valuable in determining the real underlying reasons for medical errors that lead to unexpected adverse patient outcomes.