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Licensed Unlicensed Requires Authentication Published by De Gruyter October 31, 2019

Diagnostic error in an ophthalmic emergency department

  • Harry Yip ORCID logo EMAIL logo , Carmel Crock and Elsie Chan
From the journal Diagnosis

Abstract

Background

Diagnostic error is a major preventable cause of harm to patients. There is currently limited data in the literature on the rates of misdiagnosis of doctors working in an ophthalmic emergency department (ED). Misdiagnosis was defined as a presumed diagnosis being proven incorrect upon further investigation or review.

Methods

In this retrospective audit, data was collected and analysed from 1 week of presentations at the Royal Victorian Eye and Ear Hospital (RVEEH) ED.

Results

There were 534 ophthalmic presentations during the study period. The misdiagnosis rates of referrers were: general practitioners (30%), optometrists (25.5%), external hospital EDs (18.8%), external hospital ophthalmology departments (25%) and private ophthalmologists (0%). Misdiagnosis rates of RVEEH doctors were: emergency registrars (7.1%), RVEEH residents (16.7%), first-year registrars (5.1%), second-year registrars (7.1%), third-year registrars (7.7%), fourth-year registrars (0%), senior registrars (6.9%), fellows (0%) and consultants (8.3%).

Conclusions

The misdiagnosis rates in our study were comparable to general medical diagnostic error rates of 10–15%. This study acts as a novel pilot; in the future, a larger-scale multi-centre audit of ophthalmic presentations to general emergency departments should be undertaken to further investigate diagnostic error.


Corresponding author: Dr. Harry Yip, MBBS, Royal Victorian Eye and Ear Hospital, 32 Gisborne St, East Melbourne, VIC 3002, Australia, Phone: +61 431 714 196

  1. Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

  2. Research funding: None declared.

  3. Employment or leadership: None declared.

  4. Honorarium: None declared.

  5. Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

References

1. Graber ML. The incidence of diagnostic error in medicine. BMJ Qual Saf 2013;22(Suppl 2):ii21–7.10.1136/bmjqs-2012-001615Search in Google Scholar PubMed PubMed Central

2. Berner ES, Graber ML. Overconfidence as a cause of diagnostic error in medicine. Am J Med 2008;121(5 Suppl):S2–23.10.1016/j.amjmed.2008.01.001Search in Google Scholar PubMed

3. Statham MO, Sharma A, Pane AR. Misdiagnosis of acute eye diseases by primary health care providers: incidence and implications. Med J Aust 2008;189:402–4.10.5694/j.1326-5377.2008.tb02091.xSearch in Google Scholar PubMed

Received: 2019-06-20
Accepted: 2019-10-17
Published Online: 2019-10-31
Published in Print: 2020-05-26

©2020 Walter de Gruyter GmbH, Berlin/Boston

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