Safety Climate and Medical Errors in 62 US Emergency Departments - 20/10/12

Doi : 10.1016/j.annemergmed.2012.02.018

Carlos A. Camargo, MD, DrPH ^a,^b,^⁎ , Chu-Lin Tsai, MD, ScD ^a, Ashley F. Sullivan, MS, MPH ^a, Paul D. Cleary, PhD, MPH ^d, James A. Gordon, MD, MPA ^a,^b, Edward Guadagnoli, PhD ^e, Rainu Kaushal, MD, MPH ^f, David J. Magid, MD, MPH ^g, Sowmya R. Rao, PhD ^c, David Blumenthal, MD, MPP ^b,^h,^{^{Members of the Emergency Medicine Network and the principal investigators at the 62 participating sites are listed in the Appendix.}}
^a Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
^b Mongan Institute for Health Policy, Massachusetts General Hospital, Harvard Medical School, Boston, MA
^c Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA
^d Yale School of Public Health, Yale School of Medicine, New Haven, CT
^e Department of Health Care Policy, Harvard Medical School, Boston, MA
^f Weill Cornell Medical College and New York–Presbyterian Hospital, New York, NY
^g Institute for Health Research, Kaiser Permanente Colorado and the Departments of Emergency Medicine and Preventive Medicine and Biometrics, University of Colorado Denver, Aurora, CO
^h Office of the National Coordinator for Health Information Technology, Department of Health and Human Services, Washington, DC

Address for correspondence: Carlos A. Camargo, Jr, MD, DrPH

Résumé

Study objective

We describe the incidence and types of medical errors in emergency departments (EDs) and assess the validity of a survey instrument that identifies systems factors contributing to errors in EDs.

Methods

We conducted the National Emergency Department Safety Study in 62 urban EDs across 20 US states. We reviewed 9,821 medical records of ED patients with one of 3 conditions (myocardial infarction, asthma exacerbation, and joint dislocation) to evaluate medical errors. We also obtained surveys from 3,562 staff randomly selected from each ED; survey data were used to calculate average safety climate scores for each ED.

Results

We identified 402 adverse events (incidence rate 4.1 per 100 patient visits; 95% confidence interval [CI] 3.7 to 4.5) and 532 near misses (incidence rate 5.4 per 100 patient visits; 95% CI 5.0 to 5.9). We judged 37% of the adverse events, and all of the near misses, to be preventable (errors); 33% of the near misses were intercepted. In multivariable models, better ED safety climate was not associated with fewer preventable adverse events (incidence rate ratio per 0.2-point increase in ED safety score 0.82; 95% CI 0.57 to 1.16) but was associated with more intercepted near misses (incidence rate ratio 1.79; 95% CI 1.06 to 3.03). We found no association between safety climate and violations of national treatment guidelines.

Conclusion

Among the 3 ED conditions studied, medical errors are relatively common, and one third of adverse events are preventable. Improved ED safety climate may increase the likelihood that near misses are intercepted.

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Plan

Introduction

Materials and Methods

Study Design and Setting

Outcome Measures

Primary Data Analyses

	Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist. This study was supported by grant R01 HS013099 from the Agency for Healthcare Research and Quality (Rockville, MD).
	Please see page 556 for the Editor's Capsule Summary of this article.
	Supervising editor: David L. Schriger, MD, MPH
	Author contributions: CAC, PDC, JAG, EG, RK, DJM, SRR, and DB conceived and designed the study. DB obtained research funding. CAC, AFS, JAG, DJM, and DB collected the data. CAC and C-LT analyzed the data and drafted the article. All authors contributed substantially to article revision. CAC supervised the study and takes responsibility for the paper as a whole.
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