Evaluation of clinically significant adverse events in patients discharged from a tertiary-care emergency

Objective To investigate the reasons for the occurrence of clinically significant adverse events (CSAEs) in emergency department-discharged patients through emergency physicians ’ (EPs) subjective reasoning and senior EPs ’ objective evaluation. Design This was a combined prospective follow-up and retrospective review of cases of consecutive adult non-traumatic patients who presented to a tertiary-care emergency department in Taiwan between 1 September 2005 and 31 July 2006. Data were extracted from ‘on-duty EPs ’ subjective reasoning for discharging patients with CSAEs (study group) and without CSAEs (control group) ’ and ‘objective evaluation of CSAEs by senior EPs, using clinical evidences such as recording history, physical examinations, laboratory/radiological examinations and observation of inadequacies in the basic management process (such as recording history, physical examinations, laboratory/radiological examinations and observation) as the guide’. Subjective reasons for discharging patients ’ improvement of symptoms, and the certainty of safety of the discharge were compared in the two groups using c2 statistics or t test. Results Of the 20 512 discharged cases, there were 1370 return visits (6.7%, 95 % CI 6.3 % to 7%) and 165 CSAEs due to physicians ’ factors (0.82%, 95 % CI 0.75% to 0.95%). In comparisons between the study group and the control group, only some components of discharge reasoning showed a significant difference (p<0.001). Inadequacies in the basic management process were the main cause of CSAEs (164/165). Conclusion The authors recommended that EP follow-up of the basic management processes (including history record, physical examination, laboratory and radiological examinations, clinical symptoms/signs and treatment) using clinical evidence as a guideline should be made mandatory