Voluntarily Reported Emergency Department Errors

Abstract

Objective: To describe voluntarily reported errors in an Emergency Department using a reward-based system. Methods: Prospective, observational study in urban, academic Emergency Department with 107,000 annual visits. All Emergency Department staff with direct patient contact voluntarily reported medical errors on a standardized form. Staff received $5 for each completed form. Rates were expressed with 95% confidence intervals (95% CI). Results: During 31 consecutive days, 9308 patients were cared for by 209 staff. Sixty-eight staff (33%) generated 209 reports, identifying 203 nonduplicative errors (22 per 1000 registered patients, 95% CI: 19, 25) on 183 patients. Nurses made 33% of the reported errors, physicians/physician assistants 22%, clerical staff 10%, technicians/orderlies 4%, non Emergency Department staff 19%, and unknown 12%. Error rates per 1000 hours worked were similar for nurses (6.6, 95% CI: 4.8, 8.0) and physicians/physician assistants (6.0, 95% CI: 4.0, 7.5). Staff activities at the time of the error were: ordering 23%, giving medication 9%, assessing patient 9%, registering patient 9%, doing procedure 8%, charting 6%, stocking 6%, filing 4%, and other 22%. Staff recovered 96 (47%) of the 203 errors before they impacted the patient: 60% by nurses and 34% by physicians and physician assistants. Patient impact for unrecovered errors were: no impact 29%, increased length of stay 56%, minor or potentially adverse events 11%, and major adverse events 4%. Conclusions: Half of reported Emergency Department errors are recovered, most often by nurses. The majority of unrecovered errors negatively impact patients, most often resulting in delays.