Nearly one-third of emergency department visits involve nonideal care events

The fast-paced, urgent, and crowded activities of emergency departments (EDs) make them particularly vulnerable to medication errors and other types of unfavorable patient care situations (nonideal care events). In fact, a new study found that nearly one-third of ED visits involved nonideal care events such as missed diagnoses. Most of these situations involved delays in and failures in care processes, notes Agency for Healthcare Research and Quality (AHRQ) researcher Kendall K. Hall, M.D. She and colleagues focused on the adult section of an ED located in a large, urban, academic medical center.

After patients were discharged from the ED, trained assistants interviewed caregivers about the patient treatment experience. They were specifically asked to describe any nonideal aspects of care. The study sample's 482 patient visits were randomly selected from all three shifts and all days of the week, covering 656 hours of time in the ED. The researchers conducted a total of 1,180 interviews with physicians, residents, nurses, and technicians.

Overall, 263 nonideal care events were reported. Nearly one-third (32 percent) of the 482 patient visits involved nonideal care events. More than half of these events (53 percent) were reported by nurses. Segments of care with the highest percentage of events were diagnostic testing (29 percent), patient disposition (21 percent), evaluation (18 percent), and treatment (14 percent). Process-related delays were the most frequently reported nonideal events within the categories of medication delivery (53 percent), laboratory testing (88 percent), and radiology testing (79 percent). Only 14 nonideal patient care events resulted in harm to patients.

More details are in "Incidence and types of non-ideal care events in an emergency department," by Dr. Hall, Stephen M. Schenkel, M.D., Jon Mark Hirshon, M.D., and others in the Quality & Safety in Health Care published online August 19, 2010. Reprints (AHRQ Publication No. 11-R015) are available from the AHRQ Publications Clearinghouse.

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