title: Safety climate and medical errors in 62 US emergency departments.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. ccamargo@partners.org
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Camargo
authors.forename: Chu-Lin
authors.initials: CL
authors.lastname: Tsai
authors.forename: Ashley F
authors.initials: AF
authors.lastname: Sullivan
authors.forename: Paul D
authors.initials: PD
authors.lastname: Cleary
authors.forename: James A
authors.initials: JA
authors.lastname: Gordon
authors.forename: Edward
authors.initials: E
authors.lastname: Guadagnoli
authors.forename: Rainu
authors.initials: R
authors.lastname: Kaushal
authors.forename: David J
authors.initials: DJ
authors.lastname: Magid
authors.forename: Sowmya R
authors.initials: SR
authors.lastname: Rao
authors.forename: David
authors.initials: D
authors.lastname: Blumenthal
mesh_terms: D004636:Emergency Service, Hospital / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D015994:Incidence; D008297:Male; D019300:Medical Errors / Q000517:prevention & control / Q000706:statistics & numerical data*; D008875:Middle Aged; D015279:Organizational Culture; D061214:Patient Safety / Q000592:standards / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology