title: Miss and missed diagnosed cases at the emergency department of king fahd hospital of the university in khobar, king saudi arabia.
abstract: BACKGROUND
  Medical errors in the emergency department (ED) are common, and proportion of preventable adverse events is among the highest for all areas of medical care. Some of the most common types of medical mistakes in ED include misdiagnosis, medication errors, surgery errors, nosocomial infections, laboratory test errors, and administrative errors. The present work aims to assess rate and identify contributing factors to miss and missed diagnoses at the ED of King Fahd Hospital of the University (KFHU) in Khobar, KSA.
  
  
  METHODS
  It is a retrospective cohort study. Target population was medical records and database of inpatients admitted from the ED to the study hospital during the year 2007 and the study sample amounted to 441 cases. Accuracy of the diagnosis in the present study was assessed by comparing the degree of matching between ED diagnosis and the final discharge diagnosis using (ICD-9-CM) diagnostic codes. Accuracy of diagnosis was divided into four main categories: fully matched, partially matched, unmatched and symptoms& unspecific. However, missed diagnosis was defined as cases where the ED diagnosis was not documented in the ED sheet.
  
  
  RESULTS
  Missed diagnosis represented (8.4%), fully/partially matched diagnosis was 62.3%, unmatched diagnosis was 10.7% and symptoms & unspecific diagnosis was (18.6%). Consultants experienced high percentage of fully/partially matched diagnosis (65.3%), while interns experienced high percentage of unmatched diagnosis (26.3%). The percentage of unmatched diagnosis at night shifts was relatively high 18.9%. Also, slightly more than one fifth of cases were diagnosed as symptoms & unspecific at evening shifts (21.2%).
  
  
  CONCLUSIONS
  Percentages of missed and unmatched diagnoses were relatively high. Also, percentage of unmatched diagnosis at night shifts and symptoms & unspecific diagnosis at evening shifts were high. The level of performance of interns was low in comparison to consultants leading to high percentage of unmatched diagnosis. Continuous medical education and training of ED physicians especially junior staff to continually improve their knowledge and skills, appropriate supervision of the medical staff to ensure competence, and proper manpower planning and recruitment to compensate for shortage of the ED medical staff especially at night shifts were highly recommended.
authors.affiliation: Health Administration and Behavioural Sciences, High Institute of Public Health, Alexandria University, Egypt. azzaelmahali@yahoo.com.
authors.forename: Azza A
authors.initials: AA
authors.lastname: El-Mahalli
authors.forename: Samiha A
authors.initials: SA
authors.lastname: Mokhtar