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Emergency medicine: A practice prone to error?

Published online by Cambridge University Press:  21 May 2015

Pat Croskerry*
Department of Emergency Medicine, Dartmouth General Hospital Site, Capital District Health Authority, Dartmouth, NS Department of Emergency Medicine, Dalhousie University, Halifax, NS
Douglas Sinclair
Department of Emergency Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, NS
Department of Emergency Medicine, Dartmouth General Hospital Site, Capital District Health Authority, 325 Pleasant St., Dartmouth NS B2Y 4G8; fax 902 465–1129,,


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The last decade has witnessed a rapidly growing public and academic interest in medical error, an interest that has culminated in the emergence of the science of error prevention in health care. The impact of this new science will be felt in all areas of medicine but perhaps especially in emergency medicine (EM). The emergency department’s unique operating characteristics make it a natural laboratory for the study of error. These characteristics, combined with the complex and myriad activities of EM, predict vulnerability to a multitude of errors. Overcrowding and other resource limitations impair continuous quality improvement, and many errors result from high decision density, excessive cognitive load and flawed thinking in the decision-making process. A large proportion of these errors have serious outcomes but an even higher proportion are preventable.

The historical practice of blaming individuals for errors needs to be replaced by root-cause analysis that identifies process and systemic weaknesses. Quantitative and qualitative methods are needed to detect, describe and classify error at all levels in the system. Research is needed into the processes that underlie EM error. Educational initiatives should be developed at all levels, for everyone from undergraduate trainees to practicing emergency physicians. Changes in societal attitudes will be an important component of the new culture of patient safety.

A nationwide reporting system is proposed to disseminate error information expediently. Canadian EM providers are in a pivotal position to provide leadership to the Canadian health care system in this important area.



Au cours de la dernière décennie, la question de l’erreur médicale a suscité un intérêt grandissant parmi le grand public et le milieu universitaire. Cet intérêt s’est traduit par l’émergence de la science de la prévention de l’erreur dans les soins de santé. L’impact de cette nouvelle science sera ressenti dans tous les domaines de la médecine, mais peut-être plus particulièrement en médecine d’urgence (MU). Les caractéristiques de fonctionnement uniques du département d’urgence en font un laboratoire naturel pour l’étude de l’erreur. Ces caractéristiques, combinées aux activités complexes et diversifiées de la MU, rendent le département d’urgence particulièrement vulnérable à une multitude d’erreurs. L’encombrement et autres limitations des ressources entravent l’amélioration continue de la qualité et de nombreuses erreurs sont le résultat d’un volume décisionnaire important, d’une charge cognitive excessive et de raisonnements imparfaits dans le processus de prise de décision. Une grande proportion de ces erreurs entraîne des résultats graves, mais une proportion encore plus grande est évitable.

L’attitude traditionnelle selon laquelle les individus sont blâmée pour les erreurs commises doit être remplacée par une analyse des causes premières de ces erreurs qui identifie les faiblesses au niveau des processus et du système. Des méthodes quantitatives et qualitatives sont nécessaires pour déceler, décrire et classifier les erreurs à tous les niveaux du système. On doit effectuer des recherches sur les processus qui sont à la base des erreurs en MU. Des initiatives éducatives doivent être mises sur pied à tous les niveaux, autant pour les étudiants du niveau post-universitaire que pour les médecins d’urgence en pratique active. Un changement sociétal d’attitude constituera une composante importante de cette nouvelle philosophie axée sur la sécurité des patients.

Un système d’information à l’échelle nationale est proposé visant à disséminer de manière opportune l’information au sujet des erreurs. Les dispensateurs de soins dans les urgences canadiennes occupent une position privilégiée pour agir à titre de chefs de file au sein du système de santé canadien dans ce domaine important.

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