According to a study released in 2016, medical errors across all ages kill more than a quarter-million (251,454) people annually. That would make medical errors the third-largest killer in the U.S., behind heart disease and cancer. The study’s authors believe the true number is higher, because the figure mentioned does not include nursing home and at-home deaths.
Medical errors run the gamut from medications given at the wrong dosage, to X-rays read backwards, to surgeries performed on incorrect body parts or organs. Single mistakes are not usually the problem. Instead, it is often a “cascade of errors” because the safeguards to prevent the compounding of mistakes were either not present or did not work.
Emergencies create their own stresses and chances for mistakes by medical professionals. With a child in an emergency situation, some of these risks increase.
Errors in Two Pediatric ER Cases
The term “cascades of errors” means that, at each stage of treatment, each new medical professional commits one or more mistakes that compound the original error. For example, in 2012, a 12-year-old in New York died from toxic shock due to a streptococcal bacterial infection. Misdiagnosis of the real problem arose from the following errors committed in the ER:
- Because gastroenteritis was already present, it was considered the likely reason for the girl’s symptoms.
- Too much reliance was placed on the diagnosis given by the referring medical professional, and that diagnosis was assumed to be correct.
- New information was not considered while diagnosing the patient, nor did the medical professionals listen to what the patient had to say.
- The recorded vital signs did not include a temperature.
- Abnormal lab results were not appraised or were not acted on.
- The vital signs taken before discharging the patient were not reviewed by the doctor.
Each of these errors built upon the previous ones, confirming an erroneous diagnosis and an inappropriate discharge from the ER that led to the girl’s death.
In another ER case, a 17-month-old girl’s weight was listed as 25 kilograms instead of 25 pounds. As a result, she received antibiotic dosages that were twice the size they should have been until the error was caught by the child’s mother, a medical student. While the child ended up suffering no lasting harm in this particular case, it illustrates the problem of prescribing errors. Such errors can occur with children in the ER because medication dosages are often based on body weight.
Error #1: Prescribing Errors
Over 40 percent of fatalities related to medications are due to incorrect dosages in persons of all ages, but the young are especially at risk. Recording the weight of an infant or child incorrectly can cause a cascade of errors as the incorrect weight follows the child throughout the hospital visit. For that reason, the American Academy of Pediatrics has recommended that children be weighed only in kilograms, and that electronic medical records (EMRs) be configured to allow weight entries only in kilograms. Additionally, a patient’s weight in kilograms should be specified on all prescriptions and on all documentation when the child is “handed off” from one medical professional to another.
Error #2: Laboratory Errors
In a paper published in the October, 2016, edition of Pediatric Emergency Care, laboratory errors of various types and severities in pediatric ERs were studied. Some of the results included the following discoveries:
- Most of the pediatric lab errors occurred in the pre-analytic phase, meaning errors in specimen collection, mislabeled specimens, or lost specimens, which delayed obtaining results.
- Approximately 17.4 percent of patients were harmed by lab errors and required treatment. That’s more than 1 patient in every 6.
- Human factors were by far the most common reason for errors, showing up as the significant factor in 82.8 percent of lab reports.
Error #3: Diagnosis Difficulties
Admittedly, children can be more difficult to diagnose because certain symptoms, such as vomiting, can indicate a full range of medical possibilities, from the relatively mild to the lethal (such as meningitis or encephalitis). If children are not quickly and accurately diagnosed, they can deteriorate more rapidly than adults when they do not respond to ER treatments, reaching the point of no return and eventual death. Because of their size and physical immaturity, some dangerous ER situations that are often specific to children are:
- The blood infection meningococcemia leads to death more quickly in those under 5, so a rapid diagnosis is essential.
- Hypovolemic shock, or insufficient blood volume, is a leading cause of pediatric death. Infants and children cannot lose much blood without the risk of hypovolemic shock.
- Children brought into the ER because of smoke inhalation or carbon monoxide poisoning can die more quickly than adults because their metabolisms run at a faster rate.
An inaccurate or delayed diagnosis is the root cause of some ER tragedies.
The Possibility of Negligence
Because errors in the ER can cascade, injury and death can be due to negligence on the part of one or more medical professionals. Incorrectly taken or incorrectly recorded vital signs, laboratory errors, incorrect or delayed diagnoses, medication errors, and inappropriate release from the ER instead of admitting the child to the hospital can all be considered negligent actions, depending on the circumstances. If you are concerned about an ER visit that resulted in harm to your child, we hope you’ll contact someone who cares—medical malpractice attorney Mike Stephenson.