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Use of Physician Concerns and Patient Complaints as Quality Assurance Markers in Emergency Medicine

INTRODUCTION: The value of using patient- and physician-identified quality assurance (QA) issues in emergency medicine remains poorly characterized as a marker for emergency department (ED) QA. The objective of this study was to determine whether evaluation of patient and physician concerns is usefu...

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Autores principales: Gurley, Kiersten L., Wolfe, Richard E., Burstein, Jonathan L., Edlow, Jonathan A., Hill, Jason F., Grossman, Shamai A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Department of Emergency Medicine, University of California, Irvine School of Medicine 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5102603/
https://www.ncbi.nlm.nih.gov/pubmed/27833684
http://dx.doi.org/10.5811/westjem.2016.9.30578
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author Gurley, Kiersten L.
Wolfe, Richard E.
Burstein, Jonathan L.
Edlow, Jonathan A.
Hill, Jason F.
Grossman, Shamai A.
author_facet Gurley, Kiersten L.
Wolfe, Richard E.
Burstein, Jonathan L.
Edlow, Jonathan A.
Hill, Jason F.
Grossman, Shamai A.
author_sort Gurley, Kiersten L.
collection PubMed
description INTRODUCTION: The value of using patient- and physician-identified quality assurance (QA) issues in emergency medicine remains poorly characterized as a marker for emergency department (ED) QA. The objective of this study was to determine whether evaluation of patient and physician concerns is useful for identifying medical errors resulting in either an adverse event or a near-miss event. METHODS: We conducted a retrospective, observational cohort study of consecutive patients presenting between January 2008 and December 2014 to an urban, tertiary care academic medical center ED with an electronic error reporting system that allows physicians to identify QA issues for review. In our system, both patient and physician concerns are reviewed by physician evaluators not involved with the patients’ care to determine if a QA issue exists. If a potential QA issue is present, it is referred to a 20-member QA committee of emergency physicians and nurses who make a final determination as to whether or not an error or adverse event occurred. RESULTS: We identified 570 concerns within a database of 383,419 ED presentations, of which 33 were patient-generated and 537 were physician-generated. Out of the 570 reports, a preventable adverse event was detected in 3.0% of cases (95% CI = [1.52–4.28]). Further analysis revealed that 9.1% (95% CI = [2–24]) of patient complaints correlated to preventable errors leading to an adverse event. In contrast, 2.6% (95% CI = [2–4]) of QA concerns reported by a physician alone were found to be due to preventable medical errors leading to an adverse event (p=0.069). Near-miss events (errors without adverse outcome) trended towards more accurate reporting by physicians, with medical error found in 12.1% of reported cases (95% CI = [10–15]) versus 9.1% of those reported by patients (95% CI = [2–24] p=0.079). Adverse events in general that were not deemed to be due to preventable medical error were found in 12.1% of patient complaints (95% CI = [3–28]) and in 5.8% of physician QA concerns (95% CI = [4–8]). CONCLUSION: Screening and systemized evaluation of ED patient and physician complaints may be an underutilized QA tool. Patient complaints demonstrated a trend to identify medical errors that result in preventable adverse events, while physician QA concerns may be more likely to uncover a near miss.
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spelling pubmed-51026032016-11-10 Use of Physician Concerns and Patient Complaints as Quality Assurance Markers in Emergency Medicine Gurley, Kiersten L. Wolfe, Richard E. Burstein, Jonathan L. Edlow, Jonathan A. Hill, Jason F. Grossman, Shamai A. West J Emerg Med Patient Safety INTRODUCTION: The value of using patient- and physician-identified quality assurance (QA) issues in emergency medicine remains poorly characterized as a marker for emergency department (ED) QA. The objective of this study was to determine whether evaluation of patient and physician concerns is useful for identifying medical errors resulting in either an adverse event or a near-miss event. METHODS: We conducted a retrospective, observational cohort study of consecutive patients presenting between January 2008 and December 2014 to an urban, tertiary care academic medical center ED with an electronic error reporting system that allows physicians to identify QA issues for review. In our system, both patient and physician concerns are reviewed by physician evaluators not involved with the patients’ care to determine if a QA issue exists. If a potential QA issue is present, it is referred to a 20-member QA committee of emergency physicians and nurses who make a final determination as to whether or not an error or adverse event occurred. RESULTS: We identified 570 concerns within a database of 383,419 ED presentations, of which 33 were patient-generated and 537 were physician-generated. Out of the 570 reports, a preventable adverse event was detected in 3.0% of cases (95% CI = [1.52–4.28]). Further analysis revealed that 9.1% (95% CI = [2–24]) of patient complaints correlated to preventable errors leading to an adverse event. In contrast, 2.6% (95% CI = [2–4]) of QA concerns reported by a physician alone were found to be due to preventable medical errors leading to an adverse event (p=0.069). Near-miss events (errors without adverse outcome) trended towards more accurate reporting by physicians, with medical error found in 12.1% of reported cases (95% CI = [10–15]) versus 9.1% of those reported by patients (95% CI = [2–24] p=0.079). Adverse events in general that were not deemed to be due to preventable medical error were found in 12.1% of patient complaints (95% CI = [3–28]) and in 5.8% of physician QA concerns (95% CI = [4–8]). CONCLUSION: Screening and systemized evaluation of ED patient and physician complaints may be an underutilized QA tool. Patient complaints demonstrated a trend to identify medical errors that result in preventable adverse events, while physician QA concerns may be more likely to uncover a near miss. Department of Emergency Medicine, University of California, Irvine School of Medicine 2016-11 2016-10-07 /pmc/articles/PMC5102603/ /pubmed/27833684 http://dx.doi.org/10.5811/westjem.2016.9.30578 Text en © 2016 Gurley et al. http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) License. See: http://creativecommons.org/licenses/by/4.0/
spellingShingle Patient Safety
Gurley, Kiersten L.
Wolfe, Richard E.
Burstein, Jonathan L.
Edlow, Jonathan A.
Hill, Jason F.
Grossman, Shamai A.
Use of Physician Concerns and Patient Complaints as Quality Assurance Markers in Emergency Medicine
title Use of Physician Concerns and Patient Complaints as Quality Assurance Markers in Emergency Medicine
title_full Use of Physician Concerns and Patient Complaints as Quality Assurance Markers in Emergency Medicine
title_fullStr Use of Physician Concerns and Patient Complaints as Quality Assurance Markers in Emergency Medicine
title_full_unstemmed Use of Physician Concerns and Patient Complaints as Quality Assurance Markers in Emergency Medicine
title_short Use of Physician Concerns and Patient Complaints as Quality Assurance Markers in Emergency Medicine
title_sort use of physician concerns and patient complaints as quality assurance markers in emergency medicine
topic Patient Safety
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5102603/
https://www.ncbi.nlm.nih.gov/pubmed/27833684
http://dx.doi.org/10.5811/westjem.2016.9.30578
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