AHRQ Misdiagnosis Study Sounds False Alarm About America’s Emergency Rooms

CME Anytime - Emergency Medicine

Doctor Jesse Pines is the National Director of Clinical Innovation at US Acute Care Solutions. Dr Pines most recently served as Director of the Center for Healthcare Innovation and Policy Research and a Professor of Emergency Medicine at the George Washington University School of Medicine and Health Sciences. He has been a Professor of Health Policy and Management at the GW Milken Institute School of Public Health and also was the principal investigator for Urgent Matters, a program that disseminates information on best practices in emergency care for eight years.

The Problem:
On December 15, the New York Times published an article entitled "E. R. Doctors Misdiagnosed Patients with Unusual Symptoms." The article was based on a study published by the Agency for Healthcare Research and Quality that was entitled "Diagnostic Errors in the Emergency Department: A Systematic Review."

The study has 15 authors with the lead author being David E. Newman-Toker, MD, PhD. In addition to the 15 authors there are seven Key Informants whose job was to provide input on the priority areas for research and synthesis. In addition, there was a panel of six Technical Experts whose job was to design the studies questions and methodology. Finally, there were four Peer Reviewers - Dr Pines was both a Technical Expert and Peer Reviewer of the paper. The paper is 744 pages long with 222 references. The study found 279 citations related to the topic.

One prominent source of concern of emergency physicians was the fact that it was assumed that emergency care provided in some countries was comparable to that in the United States. The authors included studies if they were conducted in the United States, Canada, United Kingdom, Western Europe, Australia, or New Zealand because the advisors to the study felt these countries and regions had roughly comparable systems of ED care to those found in the United States. U.S. emergency physicians, most Board Certified in EM, refute that assertion and push back immediately.

"In addition to making misleading, incomplete and erroneous conclusions from the literature reviewed, the report conveys a tone that inaccurately characterizes and unnecessarily disparages the practice of emergency medicine in the United States," Dr. Christopher S. Kang, the president of the American College of Emergency Physicians, said in a statement."As with all medical specialties, there is room for improvement in the diagnostic accuracy of emergency care," Dr. Kang added. "All of us who practice emergency medicine are committed to improving care and reducing diagnostic error.""While most medical specialties have similar training in Western nations, emergency medicine does not," he said.

The Study Sought the Answers to Three Key Questions

1. What clinical conditions are associated with the greatest number and highest risk of ED diagnostic errors and associated harms?
2. Overall and for the clinical conditions of interest, how frequent are ED diagnostic errors and associated harms?
3. Overall and for the clinical conditions of interest, what are the major causal factors associated with ED diagnostic errors and associated harms?

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