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
N1 - Funding Information:
This research was supported by grant R01 LM07894 from the National Library of Medicine to Vimla Patel. We thank the nurses, doctors and the administrative staff at the New York Presbyterian Hospital—Columbia University Medical Center Emergency Department for their participation and support of this study. Special thanks are extended to the subjects who participated in the interview portion of our project.
PY - 2008/3
Y1 - 2008/3
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
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U2 - 10.1016/j.ijmedinf.2007.04.011
DO - 10.1016/j.ijmedinf.2007.04.011
M3 - Article
C2 - 17560165
AN - SCOPUS:38749114621
SN - 1386-5056
VL - 77
SP - 169
EP - 175
JO - International Journal of Medical Informatics
JF - International Journal of Medical Informatics
IS - 3
ER -