Diagnostic errors related to acute abdominal pain in the emergency department.

Bruno, Michael mbruno at HMC.PSU.EDU
Fri Nov 20 15:51:33 UTC 2015

Thanks, Julianne, Thanks Ruth.

I’m convinced that a great many diagnostic errors could be avoided by simply improving the quality & comprehensiveness of the H&P.  At our institution, specialist physicians will typically only elicit a focused history within their proscribed purview, and then go on to physically examine only their own small bit of “territory.”  My own PCP has also never done a complete H&P on me, and I’ve been seeing him for years!  It seems to me that the only people who actually perform a comprehensive “top to bottom” H&P anymore are the medical students (who pay us for the privilege).

All the best,

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Michael A. Bruno, M.D., F.A.C.R.
Professor of Radiology & Medicine
Vice Chair for Quality and Patient Safety
Chief, Division of Emergency Radiology
The Milton S. Hershey Medical Center
Penn State College of Medicine
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Hershey, PA  17033

Phone: (717) 531-8703
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e-mail: mbruno at hmc.psu.edu<mailto:mbruno at hmc.psu.edu>

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From: Julianne Nemes Walsh [mailto:nemeswalsh at GMAIL.COM]
Sent: Friday, November 20, 2015 10:28 AM
Subject: Re: [IMPROVEDX] Diagnostic errors related to acute abdominal pain in the emergency department.

Thank you Ruth, the data consistent with malpractice claim data findings and certainly an area of focus for preventative educational strategies.

On Thu, Nov 19, 2015 at 5:34 PM, Ruth Ryan <ruthryan at cox.net<mailto:ruthryan at cox.net>> wrote:
I can’t get to the whole article, but here is a link to the abstract.  http://www.ncbi.nlm.nih.gov/pubmed/26531859
Medford-Davis L, Park E, Shlamovitz G, Suliburk J, Meyer AN, Singh H. Diagnostic errors related to acute abdominal pain in the emergency department.
Emerg Med J. 2015 Nov 3. pii: emermed-2015-204754. doi: 10.1136/emermed-2015-204754. [Epub ahead of print]
Of interest, over 1/3 of high risk abdominal pain pts in the ED in this study had diagnostic errors. The most commonly missed diagnoses were gall bladder disease and UTI, confirming once again that it tends to be the most common diagnoses, not the rarest that are misdiagnosed.
2/3 of the cases had breakdowns in the diagnostic process, most often

•        history-taking

•        ordering insufficient tests

•        problems with follow-up of abnormal test results


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