Diagnostic errors in an accident and emergency department.
OBJECTIVE
To describe the diagnostic errors occurring in a busy district general hospital accident and emergency (A&E) department over four years.


METHODS
All diagnostic errors discovered by or notified to one A&E consultant were noted on a computerised database.


RESULTS
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.


CONCLUSIONS
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.
Guly
H R
HR
Accident and Emergency Department, Derriford Hospital, Plymouth PL6 8DH, UK. henry.guly@phnt.swest.nhs.uk
D003951:Diagnostic Errors / Q000517:prevention & control / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000592:standards*; D004739:England; D050723:Fractures, Bone / Q000000981:diagnostic imaging; D017052:Hospital Mortality; D006801:Humans; D008318:Malpractice / Q000706:statistics & numerical data; D008505:Medical Staff, Hospital / Q000193:education; D011787:Quality of Health Care; D011859:Radiography / Q000592:standards*