Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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An estimated 108,000 people die each year from potentially preventable iatrogenic injury. One in 50 hospitalized patients experiences a preventable adverse event. Up to 3% of these injuries and events take place in emergency departments. ⋯ Some system-level efforts in error prevention have focused on teamwork, on strengthening communication between pharmacists and emergency physicians, on automating drug dosing and distribution, and on rationalizing shifts. This article reviews the definitions, detection, and presentation of error in medicine and EM. Based on review of the current literature, recommendations are offered to enhance the likelihood of reduction of error in EM practice.
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Comparative Study
The benefit of houseofficer education on proper medication dose calculation and ordering.
Drug dosing errors commonly cause morbidity and mortality. This prospective controlled study was performed to determine: 1) residents' understanding of drug dose calculations and ordering; and 2) the short-term effect of a brief educational intervention on the skills required to properly calculate dosages and order medications. ⋯ Emergency medicine residents require specific training in calculating and executing drug ordering. A brief educational intervention significantly improved short-term performance when retested six weeks later. Long-term retention is unknown.
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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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Although interruptions have been shown in aviation and other work settings to result in error with serious and sometimes fatal consequences, little is known about interruptions in the emergency department (ED). The authors conducted an observational, time-motion task-analysis study to determine the number and types of interruptions in the ED. ⋯ Emergency physicians are "interruptdriven." Emergency physicians are frequently interrupted and many interruptions result in breaks-in-task.
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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.