Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Medical errors in emergency departments (EDs) may be an important "public health risk." Therefore, scientific public health approaches should be used to 1) assess the magnitude of emergency medical errors with surveillance methods, 2) identify causal factors of these medical errors with clinical epidemiologic methods, and 3) evaluate the effectiveness of interventions aimed at reducing or eliminating emergency medicine errors with health service research techniques. Since errors result from complex human-system interaction, research efforts should focus on actions taken by the patient, factors concerning the ED environment, and actions taken by health care workers. Other medical and nonmedical fields have already made great advancements in studying and reducing human error. Many of these advancements could readily be adapted to study emergency medical errors.
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Comparative Study
Potential errors in the diagnosis of pericardial effusion on trauma ultrasound for penetrating injuries.
To evaluate ultrasound error in patients presenting with penetrating injury with a potential for pericardial effusion. ⋯ A serious potential exists for misdiagnosing epicardial fat pads as pericardial effusion in critically ill trauma patients. Emergency physicians need to be aware of this and should consider one of two suggested alternative methods to improve the accuracy of diagnosis.
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To determine the rate of error in emergency physician (EP) interpretation of the cause of electrocardiographic (ECG) ST-segment elevation (STE) in adult chest pain patients. ⋯ Emergency physicians show a low rate of ECG misinterpretation in the patient with chest pain and STE. The clinical consequences of this misinterpretation are minimal.
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Case Reports
Clinical errors in emergency medicine: experience at the emergency department of an Italian teaching hospital.
The level of commitment in the analysis of clinical errors made in the emergency department (ED) is currently focused on organization and processes rather than on individual action. Four major cases of clinical errors made in the ED of a teaching hospital were investigated. ⋯ The authors have initiated a systematic analysis of errors made during the diagnostic workup in their ED, and the rate of clinically significant errors is tracked. A file is being created with the purpose to use it for teaching and orientation of all new staff.
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An unacceptably high rate of medical error occurs in the emergency department (ED). Professional accountability requires that EDs be managed to systematically eliminate error. This requires advocacy and leadership at every level of the specialty and at each institution in order to be effective and sustainable. ⋯ Such efforts should be coupled to systematic analysis of errors that occur. Reliable reporting is likely only if the system is based within the specialty to help ensure proper analysis and decrease threat. Ultimate success will require dedicated effort, continued advocacy, and promotion of research.