The impact of patient misidentification on patient safety

When patients are misidentified, medical errors happen. Medical errors are the third highest cause of death in the United States, according to researchers at Johns Hopkins University[i]. Many medical errors such as radiation overdoses, medication errors, and blood transfusion errors result from patient misidentification at the point of care as well as at registration. That’s why improving patient identification is the #1 National Patient Safety Goal for hospitals, as outlined by The Joint Commission.

A recent ECRI report[ii] studied 7,600 wrong-patient events and found that nearly 9% of patient identification errors resulted in temporary harm, permanent harm, or death. Examples of serious adverse events from patient misidentification included:

  • A patient was not resuscitated in the operating room because doctors pulled up the wrong health record, which included a do-not-resuscitate order
  • A patient who was not supposed to eat but was brought the wrong meal tray and nearly choked
  • A patient who was given another’s hypertension medication at 10 times the normal dose
  • An infant that was infected by hepatitis after being given breast milk from the wrong mother

Causes of patient misidentification include duplicate medical records, overlaid medical records, identity theft, and incorrect wristbands placed on the wrong patient. Duplicate medical records account for 8% of all medical records in the United States and are an ongoing safety and financial problem for hospitals. 


Identity fraud also plays a part in patient misidentification. In a medical identity theft case, fraudulent identification cards and shared insurance cards presented at the time of registration result in overlaid medical records, which can create a significant risk for clinicians, as these records may contain inaccurate medical information for the patient being treated, potentially resulting in a patient safety event.

Preventing medical errors

Positive patient identification solutions that identify patients at registration and point of care can significantly improve the accuracy of patient identification and can:

  • Reduce medical errors
  • Prevent medical identity theft
  • Eliminate duplicate medical records

Imprivata PatientSecure™ is the leading positive patient identification solution for healthcare that improves patient safety and financial outcomes through biometric identification, medical record clean-up, improved patient matching, and workflow optimization. Imprivata PatientSecure creates a 1:1 link between a patient’s unique biometric information and their individual medical records. The positive patient identification solution is conveniently embedded in the hospital information system’s workflow through integration with existing EMR, EMPI, HIS, and ADT systems. Imprivata PatientSecure is proven to help hospitals overcome their patient identification challenges resulting in improved patient safety, revenue cycle efficiency, and patient satisfaction while reducing medical identity theft and insurance fraud. Learn more here.