Diagnostic errors related to acute abdominal pain in the emergency department

In Emergency Medicine Journal, Laura Medford-Davis and colleagues evaluate possible diagnostic errors and associated process breakdowns for patients who presented to the emergency department (ED) with abdominal pain. The authors conducted a retrospective chart review of adult ED patients at an urban academic hospital, using a computerized algorithm to identify high-risk patients. They considered patients to be high-risk if they presented to the ED with abdominal pain and were discharged, but returned to the ED within 10 days and were then hospitalized.  Diagnostic errors were defined as missed opportunities to make a correct or timely diagnosis based on the evidence available during the first ED visit, regardless of patient harm, and included errors that involved both ED and non-ED providers. The authors find that diagnostic errors occurred in 35 out of 100 high-risk cases. Over two-thirds had process breakdowns involving the patient–provider encounter (most commonly history-taking or ordering additional tests) and/or follow-up and tracking of diagnostic information (most commonly follow-up of abnormal test results).