Diagnosis Errors in French Emergency Department: Lessons from the Insurer

Background: Diagnostic errors in the emergency department (ED) is a major patient safety concern. Analysis of the causes of diagnosis errors leading to claims to the insurer may aid the improvement of management of practices.

Objectives: To describe diagnostic errors declared by healthcare institutions to an medical insurer, focusing at emergency department complaints.

Methods: Review of closed claims in 2014 from a medical liability insurer in which patients had alleged a diagnostic error. Trained physicians reviewed the litigation files and associated medical records to determine root causes of diagnostics errors using prefilled forms from the Australian Patient Safety Foundation and the PRISMA medical method.

Results: A total of 107 claims were recorded and mostly corresponded to emergent conditions (85%). Trauma was the main source for diagnostic error. Chiefs of complaint were severe consequences in 52 and death in 14. According to Australian Patient Safety Foundation, leading root causes involved basic medical reasoning in 42, omission of paraclinic examinations in 5 or misinterpretation of results in 32. Circumstances participating to the occurrence of errors were organizational in 36, infrequent condition in 8, overcrowding in 5, and included patients in 32. Using the PRISMA medical method, a single root cause was identified in 24, two causes in 60, three in 20; a preferential distribution of root causes was observed toward organization (81 cases), rules based (57 cases) and skill-based failures (57 cases).

Conclusion: The analysis of claims collected by insurers is a complementary approach to improve diagnosis process especially in the setting of emergency department and emergent patients.

Keywords: emergency medicine; medical error; legal issue; insurance; diagnostic error; closed claims.