Adult ; Bone and Bones ; injuries ; Diagnostic Errors ; Fractures, Bone ; diagnosis ; therapy ; Humans ; Male ; Medical Errors ; Young Adult

PURPOSE: To investigate which factors are associated with the causes and results of medical malpractice claims on emergency medical facilities. The study analyzed the alteration of judicial precedents between before and after 1995 when the court ruled that the burden of proof was to be placed upon the accused as well as the plaintiff. METHODS: We collect 213 medical malpractice claims covering from 1953 to 2008, using a database of closed claims maintained by the Supreme Court of Korea. Of the 213 claims, 31 involved emergency medical facilities. The cases were divided into 4 groups according to the physician's specialty and the causes and results of the claims were compared among each group. The causes and results were also compared between before and after 1995. RESULTS: In the medical department, the physicians were mainly accused in connection with mis- or delayed diagnosis. In the surgical and emergency departments, the plaintiff denounced the physician generally for neglect of duty in the emergency medical service system. The tendency of the court's ruling related to the distribution of the burden of proof has been changed after 1995 and the rate of physician legal victory in the judicial precedents has declined since then. CONCLUSION: Medical malpractice claims on emergency medical facilities were mostly related to misdiagnosis or emergency medical service system. Due to the change in the court's ruling regarding the distribution of the burden of proof, emergency physicians with medical malpractice claims need to change their attitude with regards to the activeness in the claims.
Delayed Diagnosis ; Diagnostic Errors ; Emergencies ; Emergency Medical Services ; Korea ; Malpractice

OBJECTIVE: To identify the technical considerations in implementing a barcode-based medication system and propose practical solutions for successful implementation of the system. In order to reduce medical errors related to medication and blood transfusion, we analyze various factors that hinder the successful implementation of the barcode-based medication system and discuss issues involved in the effective adoption of such a system. METHODS: The barcode-based medication system of this research uses one-dimensional, barcode bands on patients' wrists and two-dimensional barcodes attached to drug bags and blood bags. PDAs with barcode reading capability and wireless networking function are used, which enables Point of Care. The business process for applying the developed system and the current status of the system usage are analyzed. RESULTS: The factors causing a variety of system failures in the demonstration and pilot periods were identified and categorized as including PDA malfunction, PDA battery discharge due to users' carelessness, confusion in reading barcodes and so on. CONCLUSIONS: It is expected that the analyzed obstructive factors and the proposed technical considerations addressed in this paper can help other hospitals implement similar barcode-based medication systems successfully. Ultimately, this research will contribute to reducing medical errors and improving quality of patient care.
Adoption ; Blood Transfusion ; Commerce ; Medical Errors ; Medication Errors ; Medication Systems ; Patient Care ; Wrist

Medication errors such as administration of wrong drugs, wrong dosage and erroneous route of administration are not rare among medical misadventures. We present an autopsy case of accidental injection of tranexamic acid instead of bupivacaine during spinal anesthesia, accompanying the quantitative result of the tranexamic acid in the blood, cerebrospinal fluid and each internal organs. We think that warning signs on syringes and ampoules, simple and unified guideline for drug administration, separative documentation of drug administration and interpersonal communication on drug information should be done to prevent this type of medical errors.
Anesthesia, Spinal ; Autopsy ; Bupivacaine ; Medical Errors ; Medication Errors ; Syringes ; Tranexamic Acid

PURPOSE: The emergency department is prone to medical errors due to the patients'acuity and complexity. Collection and monitoring of data on medical errors are essential for setting priorities and improving patient safety. METHODS: Emergency physicians report medical errors voluntarily with an intranet-based error reporting system. The system is confidential and anonymous. Data on medical errors was collected at the emergency department of a tertiary teaching hospital with approximately 76,000 annual visits, during a nine-month period from April to December 2008. The collected data was analyzed prospectively. RESULTS: Of the 238 reports collected, 204 errors were analyzed. 90.6% of the errors were related to doctors and 21% were related to nurses. Error types were classified into clinical errors (57%), medication errors (7%) and administrative errors (35%). The levels of impact on patients caused by these errors were classified as near-miss in 28 (13%), no harm in 93 (45%), mild harm in 66 (32%), lethal in 5 (2%) and death in 2 (1%) cases. Errors that occurred in the elderly group (over 60 years of age) had more harmful impact than in other age groups (p=0.0003). The causes of these errors were human in 147 (72%), systems in 23 (11%) and both human and systems in 34 (17%). Most of these errors were preventable (99%). CONCLUSION: Data collected by the intranet-based medical error reporting system is useful to classify and analyze medical errors, and is also essential in the implementation of a patient safety system.
Aged ; Anonyms and Pseudonyms ; Emergencies ; Emergency Medicine ; Hospitals, Teaching ; Humans ; Medical Errors ; Medication Errors ; Patient Safety

PURPOSE: Spontaneous Intracranial Hypotension (SIH) is rare condition and may accompany other clinical symptoms which inhibit accurate diagnosis in an emergency department (ER). Only a few studies have reported the clinical characteristics and root causes associated with SIH. This study evaluates the rate of accuracy of SIH diagnosis and compares clinical characteristics and diagnostic test results for correct versus incorrect diagnosis groups. METHODS: Medical records of SIH patients admitted to an emergency department (ER) over a twelve year period were retrospectively reviewed. Patients were grouped as having received correct or incorrect diagnosis, and their clinical characteristics and diagnostic test results were compared. In the incorrect diagnosis group, the number of times they were misdiagnosed, and the specialties of the clinic (s) they visited prior to arrival at this ER were reviewed. RESULTS: Adhering to the inclusion criteria of our study, 72 patients were enrolled with 54 patients in the correct diagnosis group and 18 patients in the incorrect diagnosis group. Of the twenty one cases in the incorrect diagnosis group, the majority 7 cases (33.3%) had been examined by an emergency physician. Among the clinical symptoms observed, there was significant variability in the location of the headache (p=0.020) and time interval between symptom onset and diagnosis (p=0.035). CONCLUSION: There were no differences in most of the clinical observations and diagnostic test results between the correct and incorrect diagnosis groups. To improve the correct diagnosis rate, it is suggested to have 'SIH' included as a differential diagnosis when encountering patients reporting headache in the emergency department. Emergency physicians should be required to recognize clinical SIH characteristics such as orthostatic headache.
Diagnosis, Differential ; Diagnostic Errors ; Diagnostic Tests, Routine ; Emergencies ; Headache ; Humans ; Intracranial Hypotension ; Medical Records ; Retrospective Studies

PURPOSE: The odontogenic sinus and fistulous tracts is the most common draining sinus and fistulous tract of the head and neck region. These are often misdiagnoses by clinicions who are not familiar with cutaneous sinus, since most of patients do not have dental symptoms. Here we present two cases of odontogenic cutaneous sinus tract which have been diagnosed after excision of epidermal cyst. METHODS: Two patients who presented with an odontogenic sinus tract draining to the skin at our institusion during the two years were enrolled in this study. We reviewed all the medical records of the patients and literature about odontogenic cutaneous sinus tract. RESULTS: Odontogenic cutaneous sinus tracts of our cases were healed after treatment of periapical odontitis and extraction of the carious tooth. CONCLUSION: The cutaneous sinus tract of dental origin is well documented condition. But its diagnosis is not always easy unless the clinicians consider the possibility of its dental origin. An understanding of the pathogenesis of odontogenic cutaneous sinus tract will lead to early correct diagnosis and proper treatment without unnecessary surgery.
Diagnostic Errors ; Epidermal Cyst ; Head ; Humans ; Medical Records ; Neck ; Skin ; Unnecessary Procedures

A peculiar liver was found in an adult male cadaver during a dissection class for undergraduate medical students. The quadrate lobe and fissure for the ligamentum teres were totally absent. Thus, the cystic notch on the inferior border was very broad and deep, and the fundus and body of the gall bladder popped out through this notch. The cystic duct terminated into the right hepatic duct at the porta hepatis instead of terminating into the common hepatic duct. Awareness of variations of the lobes and fissures may minimize a misdiagnosis of liver problems. The aim of the current study was to alert radiologists and surgeons about possible variations in the external appearance and anomalies of the lobes and fissures of the liver.
Adult ; Cadaver ; Cystic Duct ; Diagnostic Errors ; Hepatic Duct, Common ; Humans ; Liver ; Male ; Students, Medical ; Urinary Bladder

Pleomorphic adenoma (PA) is the most common benign salivary gland tumor. Histologically, squamous metaplasia has been reported in PA, but has rarely been documented as being extensive enough to cause significant misdiagnosis. Here, we present an unusual case of PA in a 50-year-old female patient presenting with swelling on the postero-lateral aspect of the palate for a week. Histopathologically, the tumor exhibited the features of conventional PA with extensive squamous metaplasia and giant keratotic lamellae in cyst-like areas. Such exuberant squamous metaplasia and keratin can be a diagnostic and prognostic pitfall and lead to overtreatment of the patient.
Adenoma, Pleomorphic ; Diagnostic Errors ; Female ; Humans ; Medical Overuse ; Metaplasia ; Middle Aged ; Palate ; Pathology ; Salivary Glands

OBJECTIVES: Uterine sarcoma is a rare malignant tumor, which is usually diagnosed in postmenopausal women. These sarcomas are occasionally misdiagnosed as uterine fibroids, thereby leading to delayed diagnosis in the advanced stages. We analyzed the sonographic and clinical characteristics of unexpected uterine sarcomas detected after surgery in women in the late reproductive age.METHODS: The medical records of 61 patients preoperatively diagnosed with uterine leiomyomas through sonography but confirmed as uterine sarcomas after surgery from January 2005 to December 2018 at Asan Medical Center were retrospectively analyzed. We evaluated the clinical symptoms, sonographic findings, and Doppler indexes, and investigated whether there were any significant characteristics that could clearly differentiate uterine sarcoma from fibroids.RESULTS: The most common clinical finding was increased mass size (15 patients, 24.6%), while 9 patients (14.8%) showed no symptoms. Ultrasonography showed that the maximum diameter of most fibroids was > 5 cm (49 patients, 80.3%), and the average diameter was 75.6 ± 36.3 mm. All the patients showed heterogeneous echogenicity in sonographic imaging. Secondary degeneration of the myomas was reported in 36 patients (59%), and approximately 90% (32/36, 88.9%) showed cystic changes. Of the 40 patients who underwent the evaluation of vascularity, 35 showed increased vascularity of the mass.CONCLUSIONS: In this study, sarcomas misdiagnosed as leiomyomas were usually > 5 cm, and ultrasonography showed heterogeneous echogenicity and irregular cystic degeneration. No definite clinical symptoms were helpful; a thorough evaluation is necessary to rule out uterine sarcomas in women having uterine mass with these characteristics.
Chungcheongnam-do ; Delayed Diagnosis ; Diagnostic Errors ; Female ; Humans ; Leiomyoma ; Medical Records ; Myoma ; Retrospective Studies ; Sarcoma ; Ultrasonography