ACEP has significant concerns about the Agency for Health Research and Quality (AHRQ) publication, Diagnostic Errors in the Emergency Department: A Systematic Review.
This report inaccurately characterizes and unnecessarily disparages the practice of emergency medicine in the U.S.
- Organizations across emergency medicine united to express concerns about its faulty premise, flawed methodology and dangerously misleading conclusions.
- Unfortunately, AHRQ ignored these concerns, which led leading emergency medicine organizations to issue a joint letter outlining flaws in the methodology and findings.
- As the letter states, “The repercussions of this faulty report cannot be overstated, as it will irresponsibly and falsely alarm the public and potentially lead them to delay or even forego treatment for time sensitive emergencies."
This report fuels the spread of misinformation about emergency departments and casting unfounded doubt on the safety and quality of emergency care in the United States.
- This misrepresentation is incorrect and offensive, but, more importantly, it could lead a person who needs emergency care to second guess whether they should go to the emergency department.
This report is based on a faulty premise then uses flawed methodology to land on false and misleading conclusions.
- The opening lines of the executive summary actually negate the sensationalized findings of the full report.
- The authors state, “Overall diagnostic accuracy in the emergency department is high,” and that only .3% of patients experience “severe adverse events” from an incorrect diagnosis.
- The report further clarifies, “these rates are comparable to those seen in primary care and inpatient hospital care.”
- The authors make an irresponsible leap to directly connect malpractice claims with missed diagnoses. However, a malpractice claim alone cannot be considered an accurate indicator of missed diagnoses on its own.
- The authors derive statistics specific to the United States using studies from Canada, Switzerland and Spain. However, emergency medicine in these nations is not directly comparable.
- Neither Spain nor Switzerland had emergency medicine residency training at the time of the research period, but emergency medicine has existed in the U.S. for decades.
- Another data point falsely attributes 250,000 deaths to diagnostic errors in emergency departments. However, this statistic cannot pass a smell test.
- If this were true, emergency department errors would be the third leading cause of death in the United States, outpacing injuries from accidents, strokes, and diseases like Alzheimer’s or diabetes.
The quality of care provided by emergency physicians is impressive considering that emergency physicians treat patients who are undifferentiated and severely ill or injured.
- Rather than final diagnosis, emergency medicine is more focused on addressing symptoms that need immediate medical attention. A definitive diagnosis may only be evident days or weeks after the emergency visit.
As with all medical specialties, there is room for improvement in the diagnostic accuracy of emergency care.
- All of us who practice emergency medicine are committed to improving care and reducing diagnostic error.
This report is a dangerous distraction that is preventing real discussion about issues that matter to emergency physicians and their patients.
- In addition to prioritizing the highest quality and safety standards, any discussion about reducing and preventing medical errors must include efforts to address the sources of systemic strain that increase the likelihood of medical errors, especially in the current environment.
To limit medical errors and enhance emergency care, more must be done to limit boarding and crowding in the emergency department, protect emergency physician mental health and safety on the job, and prioritize emergency physician-led care teams.
