Emergency department crowding and risk of preventable medical errors.
The objective of the study is to determine the association between emergency department (ED) crowding and preventable medical errors (PME). This was a retrospective cohort study of 533 ED patients enrolled in the National ED Safety Study (NEDSS) in four Massachusetts EDs. Individual patients' average exposure to ED crowding during their ED visit was compared with the occurrence of a PME (yes/no) for the three diagnostic categories in NEDSS: acute myocardial infarction, asthma exacerbation, and dislocation requiring procedural sedation. To accommodate site-to-site differences in available administrative data, ED crowding was measured using one of three previously validated crowding metrics (ED Work Index, ED Workscore, and ED Occupancy). At each site, the continuous measure was placed into site-specific quartiles, and these quartiles then were combined across sites. We found that 46 (8.6%; 95% confidence interval, 6.4-11.3%) of the 533 patients experienced a PME. For those seen during higher levels of ED crowding (quartile 4 vs. quartile 1), the occurrence of PMEs was more than twofold higher, both on unadjusted analysis and adjusting for two potential confounders (diagnosis, site). The association appeared non-linear, with most PMEs occurring at the highest crowding level. We identified a direct association between high levels of ED crowding and risk of preventable medical errors. Further study is needed to determine the generalizability of these results. Should such research confirm our findings, we would suggest that mitigating ED crowding may reduce the occurrence of preventable medical errors.
Department of Emergency Medicine, W/CC-2, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA. sepstein@bidmc.harvard.edu
Stephen K
SK
Epstein
David S
DS
Huckins
Shan W
SW
Liu
Daniel J
DJ
Pallin
Ashley F
AF
Sullivan
Robert I
RI
Lipton
Carlos A
CA
Camargo
D000293:Adolescent; D000328:Adult; D000368:Aged; D016000:Cluster Analysis; D015331:Cohort Studies; D016001:Confidence Intervals; D003441:Crowding; D004632:Emergency Medical Services / Q000592:standards / Q000639:trends; D004635:Emergency Medicine / Q000592:standards* / Q000639:trends; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006784:Hospitals, Teaching; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D019300:Medical Errors / Q000517:prevention & control* / Q000706:statistics & numerical data*; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D018570:Risk Assessment; D014481:United States; D014850:Waiting Lists; D016526:Workload / Q000706:statistics & numerical data*; D055815:Young Adult