Medical Mistakes - Preventing Emergency Room & Surgical Errors
Read about the most common A&E accidents & Surgical Errors that turn in Medical Malpractice Claims, and how to prevent them.
Blog
August 26, 2020
Medical Mistakes and Negligence Claims
Medical negligence claims can come in many shapes and forms. For a great number of years one of the most common forms of negligent claims within the healthcare industry are claims related to medical errors, where these errors have badly impacted a patients standard of care and/or living. And these medical errors happen every day. According to a recent study by University of Manchester, 1 in 6 patients suffer preventable medical mistakes during the course of their treatment. However it is estimated that 6 out of 7 medical mistakes go unreported. While these mistakes are not 100% preventable, many methods can be put in place to prevent them, reduce the impact of a mistake and protect the medical professional and patient after a mistake occurs. This article is part one of two articles discussing “Medical Mistakes” as a whole. In this first part we will be looking at:Diagnostic Errors and their common causesSurgical Errors within the UK Errors that occur within the Emergency Department A deeper look into Medical Mistakes and Error that occur in both the UK and US Healthcare Industries Methods to prevent Surgical Errors and Never Events (Risk Management)Methods to prevent Emergency Error in the Emergency Department (Risk Management)
UK Healthcare – Diagnostic Errors & the Emergency Department
Continuing with the study by University of Manchester, it has been estimated that of all reported medical errors, about half could have been prevented by following already in place medical procedures or by implementing new ones. 12% of any medication mix ups and surgical mistakes were severe or deadly to patients, leaving patients permanently disabled or dead. One important fact to bare in mind is that diagnostic errors occur more frequently in the emergency department than in regular patient hospital care. This is most likely to the inherently hectic and demanding climate that has developed within ER departments. Between 2013 and 2015, 2’288 cases diagnostic errors were confirmed. Out of this figure, 86% of these diagnostic errors occurred because diagnosis was delayed, and 14% were due to diagnostic being incorrect. If 6 out of 7 medical errors go unreported, one can only imagine the number of medical mistakes that actually occurred between 2013 and 2015. 44% of the 2’288 diagnostic errors were fractures. 7% were myocardial infractions and 6% were intracranial bleeds.
Common Causes of Diagnostic Errors
But what are the causes of major diagnostic errors, inside and outside of the emergency department?Incidents with delayed or incorrect diagnosis that occur normally are caused by or made worse by:Inadequate assessments of patient injuries/symptoms and/or patient medical recordMisinterpretation of diagnostic investigationMisinterpretation of patient record and/or patient spoken symptomsFailure to order investigation or appropriate procedureOther contributing factors may include human errors such as:Inadequate knowledge Staff not following in put protocols Staff mistakesLack of communication and cross over of knowledge Healthcare Professional may have inadequate skill set
UK Healthcare – British Surgical Errors
Various studies have been conducted by the OECD (Organisation for Economic Co-Operation and Development). One of their recent studies has shown that the UK has 5.5 cases of surgical error per 100’000 patients discharged from the hospital. Additionally, the UK has a large record of surgical errors involving never events (incidents so bad that they should never happen again to patients, due to systems put in place to prevent them). One of the most common forms of never events that occur in UK surgical errors, are where medical items and equipment have been left inside patient bodies after initial surgical treatment has been given and completed. Items that have been left inside a patients body after surgery include for example:DressingsSwabsHypodermic NeedlesSmall pieces of medical equipment Over the last year, the UK has had more than 100 Never Events. With the recent climate of the UK’s Healthcare Industry, it is more than likely that these figures may increase over the course of 2020 due to general increased pressure on the NHS and additional pressure placed on NHS services and workforce due to coronavirus.
Preventing Surgical Errors and Never Events
While it may seem shocking that never events still occur within the NHS environment today, it’s not hard to see why. Many of the basic and simple risk management methods that would make never events and surgical errors preventable aren’t in place within current NHS protocol.There are two main methods that could help prevent devastating surgical errors:
1. Counting Instruments
It is of popular belief that making counting instruments before and after a surgery a mandatory legal requirement would drastically cut down surgical errors involving surgical instruments being left behind in the body. But it would do more than help prevent and maintain accountability of the items used within surgery. It would also reduce the window of time between conducting the error and discovering the error has occurred, reducing medical and physical impact of such a mistake on the patients body. A checklist can and should be made listing every single piece of medical equipment used in the surgery. This checklist should have double tick boxes for before and after the surgery, where on both occasions, the piece of equipment is checked for presence and verbally announced out loud to the team. This way if members of the surgical team are responsible for specific equipment they can be reminded on which pieces of equipment they are countable for. Separately, should surgical errors occur despite this, and medical equipment is found to be missing once surgery is complete and the second check is being commenced, then a) it should be easier to identify who in the medical team conducting the surgery has misplaced and lost the equipment and b) less time can be wasted in-between surgery and post-op checks up to ensure the lost medical equipment is in fact not inside the patient themselves.
2. Promote Effective Communication
The phrase “communication is key” is always relevant no matter your profession within the healthcare sector. If there is more than one person conducting, or involved in, a patient’s surgery then effective communication is needed. To ensure that treatment being provided is of the appropriate kind, the surgeon, patient, doctor, and any other medical consultants involved with patient investigation/examination should all be consulted collectively. They should also be in agreement of the procedures and treatment being provided before it is provided, to ensure no errors in miscommunication have occurred in patient data transferred from the first encounter with a medical professional to the surgeon(s) conducting the final surgery. Paperwork should be updated in full and contain all essential details that will impact course of treatment provided and/or after care post-op.
US Healthcare – Medical Errors in America
While it is more than likely you are a medical practitioner looking to/currently practising within the UK, the US Healthcare Industry can provide lots of insights into how serious medical errors are, and the ways to protect against them. In the US healthcare industry almost half of medical errors occur in the emergency room due to issues related to processing patient and procedure information. Technical errors, caused by medical technology and devices, are shortcoming and account for 45% of all US Emergency room errors. Medical Errors cause 250’000 deaths per year in the US. Evidence suggests that these incidents occurred with doctors who have the right information on their patients, but failed to act in the best suited way to protect and assist their patients. Why is this the case? Just as it is in the UK, the ER department is a clinically different environment full of frequent interruptions that may lead to incomplete or unreliable evaluations regarding patients and their procedures. Studies shows that these emergency room errors occur from not just inadequate information processing, but lack of adequate knowledge on the subject of care or/and patient injury/symptoms, and having limited or inadequate information on the patient themselves. If we breakdown the average number of medical errors confirmed within the US we get the following statistics:45% of medical error cases showed staff had problems processing information31% showed staff had problems verifying information gathered on the patient6% of staff had inadequate knowledge on patient and procedures offered18% of staff conducted inadequate information gathering13% of staff misjudged significant findings and prematurely decided on incorrect diagnosis where individual staff errors occurredAdditionally, due to the nature of the ER department, in both US and UK settings, healthcare staff burnout can negatively impact and contribute to errors in decision making and overall care quality within an emergency room setting, especially if staff members are working through long shift periods with little room for regular breaks.
Preventing Emergency Department Errors
Initially, improving the quality of care within the emergency department, will help overall improve the standard of care among medical staff and therefore reduce the number of medical errors that occur overall, and reduce the impacts and severity of medical mistakes that occur regardless. A number of risk mitigation methods can be installed within the working environment of the emergency department to limit these mistakes.
1. System Modifications
System modifications may be needed to provide clinicians with better support in conducting patient assessments and investigation interpretation of patients and their medical aliments. If medical errors are regularly occurring due to a lack of system modifications in place, regardless the size of the medical practice / medical entity, these systems and protocols need to be updated to reduce risk of medical error and therefore protect the standard of care offered and the well-being of the patients.
2. Interventions
The emergency department is a prime environment for medical errors in both the UK and the US. Medical interventions may be required to reduce diagnostic errors when patients are being evaluated in an emergency department setting. Having an additional medical staff member present during examinations and patient investigation may be needed to assess performance of medical staff members dealing with patient examinations, and to cross-check patient interpretation based off the assessment. If diagnostic errors are occurring due to lack of adequate knowledge this may help:a) identify staff members with inadequate knowledge who should be transferred to a different medical department where they are less likely to make medical errors that have devastating impacts, and/or receive the proper training required to deal with patient assessments, and b) help produce on site training if staff members holding intervention is of a higher medical level and/or has adequate knowledge in comparison.
3. Methods of Intervention
Various additional methods can be added into the emergency department life cycle to catch medical errors before they occur and cross-reference medical assessments conducted. This can include standardised and mandatory checklists that are passed between staff members when patients are transferred within the emergency department to keep track of:a) initial medical assessments and b) medical history of patient. Reporting can be reorganised in a structured linear pathway to help keep reported notes and patient assessments in one way to avoid miscommunication between staff members and process information correctly. Regular technology improvements can be made to ensure standard of medical equipment, devices and machines are in working order and well looked after to help reduce the number of and avoid medical mistakes called be technical errors. To ensure machines are working day to day prior to improvements, regular daily checks before initial use should be conducted across the medical practice / medical entity to catch technical errors before they happen and therefore avoid incorrect or delayed diagnostics and medical staff member loss of time.
The Key is Risk Assessment and Management
Risk prevention is not attainable without assessment and management. When you go to work you open yourself up to medical negligence claims every single time. Claims don’t just happen in the operating theatre or the emergency room – they happen all over the healthcare industry in every department. In part two of our “Medical Mistakes” focus article we will be taking a deeper look into:Most common and reoccurring medical errors Misdiagnosis and unnecessary treatments A look at the reality of medical mistakes – misdiagnosis case study Main causes of medical mistakes and how to risk manage them One of the best and legally required ways to protect yourself from medical negligence claims is through acquiring a malpractice insurance policy that protects your role fully. We offer medical malpractice policies for a large variety of general and specialist medical professionals. There is also a silent review service for those who are scouting for alternatives from their current provider. For more information on how we can protect you, please contact us via info@servca.com or fill out one of our call back forms to have a broker call you directly.
