A visit to the emergency department is often stressful and upsetting. Patients go there because they need answers, treatment, and reassurance. When diagnosis is delayed, the consequences can be serious. A patient’s condition may worsen, treatment may be postponed, and the opportunity to prevent harm may be lost.
Recent clinical risk data highlights just how important this issue is. The State Claims Agency’s analysis found that 79% of diagnosis incidents were reported as delayed diagnosis, often linked to delayed access to diagnostic services or delays in receiving test results. It also found that more than half of diagnosis incidents arose at the tests and investigations stage.
For patients and families, these figures matter because they point to a problem that is not always dramatic at first. A delayed diagnosis may begin with a long wait, a missed sign, a delayed scan, or a failure to act on a test result. However, what starts as a delay can sometimes lead to significant injury, avoidable suffering, or, in the most serious cases, death.
Why delayed diagnosis happens in the emergency department
Emergency departments work under constant pressure. Staff must assess large numbers of people, often with limited time and resources. The SCA report’s spotlight on emergency medicine identified recurring problems linked to emergency department capacity, including overcrowding, prolonged wait times, delayed access to triage, medical assessment, diagnostics, and treatment, and delayed transfer to wards because of a lack of beds.
The same analysis also highlights inadequate monitoring and observation of patients while they were waiting, including patients deteriorating in waiting areas before assessment. Problems with communication were another important theme. These include poor communication within emergency department teams, poor communication between the emergency department and other hospital services, ineffective handover of care, inadequate referral processes, and delay or difficulty in contacting on-call staff.
In other words, delayed diagnosis is not always the result of one single mistake. It can happen because several smaller failures come together. A patient may wait too long to be assessed, test results may not be followed up quickly enough, or concerns may not be escalated to a senior clinician in time.
What the data tells us
The wider claims data in the report demonstrate why clinical risk in this area deserves attention. By the end of 2023, the State Claims Agency had 11,137 active claims, with an estimated outstanding liability of €5.18 billion. While 36% of active claims related to clinical claims, they accounted for 80% of the outstanding liability. The report also notes that rising claims costs are being driven mainly by the rising cost of individual claims, rather than by rising numbers of claims.
The emergency department review also found 67 claims related to emergency departments between 2018 and 2022. Of the top hazard categories in those claims, diagnosis accounted for 19 claims, with total paid damages of more than €2.2 million. Care management was also a major issue, with 11 claims and the highest average paid damages per claim.
This shows that diagnosis and care management problems in the emergency department are not isolated events. They are part of a wider pattern that can lead to real harm for patients and substantial legal consequences for healthcare providers.
How patients may experience delayed diagnosis
From a patient’s point of view, delayed diagnosis does not always feel obvious in the moment. It may involve being sent home too early, being told that symptoms are less serious than they really are, waiting a long time for a scan or blood test, or returning to the emergency department more than once before the true problem is identified.
The emergency department claims review found that almost half of the patients involved had presented to the emergency department on more than one occasion. The report also noted that, in various claims, patients deteriorated while waiting to be seen by a clinician.
That is important for patients and families to understand. A delayed diagnosis is not only about the first decision made in hospital. It can also involve what happened afterwards, including whether symptoms were properly reviewed, whether repeat attendances were taken seriously, and whether the patient was monitored appropriately while waiting.
Common factors behind delayed diagnosis
The report points to several recurring factors that can contribute to delay. These include delays in clinician assessment, failures in triage, difficulties accessing tests and investigations, poor communication, inadequate handover, and failures in referral or escalation. Sampling and specimen issues are also mentioned in the broader discussion of diagnosis incidents, showing that problems can arise at the testing stage as well as during examination and decision-making.
For patients, this means that harm can occur at many points in the process. The problem may be a delayed X-ray, a blood sample issue, a missed result, poor communication between teams, or a failure to appreciate that a patient’s condition is becoming more serious.
When a delay may amount to medical negligence
Not every delay in diagnosis will amount to negligence. Emergency departments are complex environments, and medicine is not an exact science. However, there are cases where a delay may amount to negligent care.
That may arise where there was an unreasonable failure to assess a patient, to order appropriate tests, to interpret those tests properly, to monitor deterioration, to refer to the right specialist, or to act on warning signs within a reasonable time. It may also arise where poor systems, poor handover, or poor communication caused an avoidable delay that led to injury.
In a legal claim, the key question is usually not whether the patient had to wait, but whether the care fell below an acceptable standard, and whether that failure caused avoidable harm.
Why this is a patient safety issue as well as a legal issue
One of the strongest messages in the report is that learning from incidents and claims should be used to reduce the risk of recurrence. The Clinical Risk Unit describes its C.L.A.I.M initiative as a way of analysing claims after settlement, sharing learning with health services, and seeking assurance that preventative measures are put in place.
That is significant because delayed diagnosis is not only about compensation after harm has happened. It is also about preventing the same mistakes from happening again. If overcrowding, long waits, poor handover, and failures in escalation keep appearing in claims and incident reviews, there is a clear patient safety imperative to address them.
What patients and families should watch for
Patients and families are not expected to diagnose their own conditions. However, there are some warning signs that may suggest a delay in care that should be looked at more closely.
These may include repeated attendance at the emergency department with the same symptoms, a long delay before assessment despite worsening condition, test results that were not explained or acted upon, discharge without clear safety advice, or a serious diagnosis being made only after a significant deterioration.
In some cases, families only begin to ask questions after they realise that earlier treatment might have made a difference. That is often when concerns about delayed diagnosis arise.
Concerned about a delayed diagnosis in the emergency department?
The data in the SCA’s report highlights delayed diagnosis as a serious patient safety issue, particularly in busy emergency departments. For patients, the impact can be life-changing, leading to prolonged pain, more complex treatment, avoidable complications, or a reduced chance of recovery.
If you have suffered harm because a diagnosis was delayed in the emergency department, it may be helpful to seek legal advice. The medical negligence team at McCarthy + Co Solicitors LLP can advise you on your options, review the circumstances of your care, and help you understand whether you may have grounds for a claim. Arrange a time to speak with a solicitor here using our confidential online form.
0 Comments