The nature and occurrence of registration errors in the emergency department

A. Forogh Hakimzada, Robert A. Green, Osman R. Sayan, Jiajie Zhang, Vimla Patel

Research output: Contribution to journalArticle

40 Citations (Scopus)

Abstract

Research into the nature and occurrence of medical errors has shown that these often result from a combination of factors that lead to the breakdown of workflow. Nowhere is this more critical than in the emergency department (ED), where the focus of clinical decisions is on the timely evaluation and stabilization of patients. This paper reports on the nature of errors and their implications for patient safety in an adult ED, using methods of ethnographic observation, interviews, and think-aloud protocols. Data were analyzed using modified "grounded theory," which refers to a theory developed inductively from a body of data. Analysis revealed four classes of errors, relating to errors of misidentification, ranging from multiple medical record numbers, wrong patient identification or address, and in one case, switching of one patient's identification information with those of another. Further analysis traced the root of the errors to ED registration. These results indicate that the nature of errors in the emergency department are complex, multi-layered and result from an intertwined web of activity, in which stress in the work environment, high patient volume and the tendency to adopt shortcuts play a significant role. The need for information technology (IT) solutions to these problems as well as the impact of alternative policies is discussed.

Original languageEnglish (US)
Pages (from-to)169-175
Number of pages7
JournalInternational Journal of Medical Informatics
Volume77
Issue number3
DOIs
StatePublished - Mar 1 2008

Fingerprint

Hospital Emergency Service
Medical Errors
Workflow
Patient Safety
Medical Records
Observation
Interviews
Technology
Research

Keywords

  • Distributed cognition
  • ED registration
  • Emergency care
  • Medical errors
  • Misidentification
  • Shortcuts
  • Workarounds

ASJC Scopus subject areas

  • Medicine(all)

Cite this

The nature and occurrence of registration errors in the emergency department. / Hakimzada, A. Forogh; Green, Robert A.; Sayan, Osman R.; Zhang, Jiajie; Patel, Vimla.

In: International Journal of Medical Informatics, Vol. 77, No. 3, 01.03.2008, p. 169-175.

Research output: Contribution to journalArticle

Hakimzada, A. Forogh ; Green, Robert A. ; Sayan, Osman R. ; Zhang, Jiajie ; Patel, Vimla. / The nature and occurrence of registration errors in the emergency department. In: International Journal of Medical Informatics. 2008 ; Vol. 77, No. 3. pp. 169-175.
@article{e11e6eb03ca54244a1f7ea2def56fce9,
title = "The nature and occurrence of registration errors in the emergency department",
abstract = "Research into the nature and occurrence of medical errors has shown that these often result from a combination of factors that lead to the breakdown of workflow. Nowhere is this more critical than in the emergency department (ED), where the focus of clinical decisions is on the timely evaluation and stabilization of patients. This paper reports on the nature of errors and their implications for patient safety in an adult ED, using methods of ethnographic observation, interviews, and think-aloud protocols. Data were analyzed using modified {"}grounded theory,{"} which refers to a theory developed inductively from a body of data. Analysis revealed four classes of errors, relating to errors of misidentification, ranging from multiple medical record numbers, wrong patient identification or address, and in one case, switching of one patient's identification information with those of another. Further analysis traced the root of the errors to ED registration. These results indicate that the nature of errors in the emergency department are complex, multi-layered and result from an intertwined web of activity, in which stress in the work environment, high patient volume and the tendency to adopt shortcuts play a significant role. The need for information technology (IT) solutions to these problems as well as the impact of alternative policies is discussed.",
keywords = "Distributed cognition, ED registration, Emergency care, Medical errors, Misidentification, Shortcuts, Workarounds",
author = "Hakimzada, {A. Forogh} and Green, {Robert A.} and Sayan, {Osman R.} and Jiajie Zhang and Vimla Patel",
year = "2008",
month = "3",
day = "1",
doi = "10.1016/j.ijmedinf.2007.04.011",
language = "English (US)",
volume = "77",
pages = "169--175",
journal = "International Journal of Medical Informatics",
issn = "1386-5056",
publisher = "Elsevier Ireland Ltd",
number = "3",

}

TY - JOUR

T1 - The nature and occurrence of registration errors in the emergency department

AU - Hakimzada, A. Forogh

AU - Green, Robert A.

AU - Sayan, Osman R.

AU - Zhang, Jiajie

AU - Patel, Vimla

PY - 2008/3/1

Y1 - 2008/3/1

N2 - Research into the nature and occurrence of medical errors has shown that these often result from a combination of factors that lead to the breakdown of workflow. Nowhere is this more critical than in the emergency department (ED), where the focus of clinical decisions is on the timely evaluation and stabilization of patients. This paper reports on the nature of errors and their implications for patient safety in an adult ED, using methods of ethnographic observation, interviews, and think-aloud protocols. Data were analyzed using modified "grounded theory," which refers to a theory developed inductively from a body of data. Analysis revealed four classes of errors, relating to errors of misidentification, ranging from multiple medical record numbers, wrong patient identification or address, and in one case, switching of one patient's identification information with those of another. Further analysis traced the root of the errors to ED registration. These results indicate that the nature of errors in the emergency department are complex, multi-layered and result from an intertwined web of activity, in which stress in the work environment, high patient volume and the tendency to adopt shortcuts play a significant role. The need for information technology (IT) solutions to these problems as well as the impact of alternative policies is discussed.

AB - Research into the nature and occurrence of medical errors has shown that these often result from a combination of factors that lead to the breakdown of workflow. Nowhere is this more critical than in the emergency department (ED), where the focus of clinical decisions is on the timely evaluation and stabilization of patients. This paper reports on the nature of errors and their implications for patient safety in an adult ED, using methods of ethnographic observation, interviews, and think-aloud protocols. Data were analyzed using modified "grounded theory," which refers to a theory developed inductively from a body of data. Analysis revealed four classes of errors, relating to errors of misidentification, ranging from multiple medical record numbers, wrong patient identification or address, and in one case, switching of one patient's identification information with those of another. Further analysis traced the root of the errors to ED registration. These results indicate that the nature of errors in the emergency department are complex, multi-layered and result from an intertwined web of activity, in which stress in the work environment, high patient volume and the tendency to adopt shortcuts play a significant role. The need for information technology (IT) solutions to these problems as well as the impact of alternative policies is discussed.

KW - Distributed cognition

KW - ED registration

KW - Emergency care

KW - Medical errors

KW - Misidentification

KW - Shortcuts

KW - Workarounds

UR - http://www.scopus.com/inward/record.url?scp=38749114621&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=38749114621&partnerID=8YFLogxK

U2 - 10.1016/j.ijmedinf.2007.04.011

DO - 10.1016/j.ijmedinf.2007.04.011

M3 - Article

VL - 77

SP - 169

EP - 175

JO - International Journal of Medical Informatics

JF - International Journal of Medical Informatics

SN - 1386-5056

IS - 3

ER -