Patient safety in emergency medicine

Scope of the problem Errors in medicine are an issue of national concern. The Institute of Medicine’s (IOM) report To Err Is Human, published in 2000, highlighted this concern and issued a warning that errors in medicine were much more common and costly than previously recognized. Following publication of this report, the medical community has developed a new focus on error, health care safety and quality. Much of what has been learned is the result of study and adaptation of systems from other complex organizations, such as the military and airline industry, as well as knowledge transfer from human factors engineering and organizational psychology. Human performance experts teach that all humans err. Therefore, errors are to be expected as a normal part of human behavior and function. Yet medical school and postgraduate training teach, and physicians ultimately swear an oath to the Hippocratic concept "above all, do no harm." This most noble of all aspirations has often been misconstrued to imply that physicians should practice error-free. Studies of human performance suggest that although we should always aspire to error-free performance, we must all come to the realization that medical errors are a regrettable but inevitable part of medical practice. Understanding medical error and being conversant in its nomenclature, processes and prevention is an important part of modern practice. The first step in this process is learning the taxonomy and language universally accepted and designed to enhance effective communication and mitigate blame. A set of definitions proposed by the IOM and adopted by the emergency medicine community is presented in Table 50.1. In a professional setting, the causes of error are complex. Although human error may contribute to incidents, many errors may be beyond the control of the individual and occur as a function of human-system interaction. The high error rate of the emergency department (ED) has been largely ascribed to environmental features associated with the complexity inherent in delivering emergency care and the required variations in work needed to fit the dynamic fluxes occurring in such a versatile health care environment. Thus, practitioners who are aware of the inevitability of medical errors, possess knowledge of error types, and understand how systems are predisposed to error are better prepared to work safely within complex systems in many cases designed to fail.