A Patient Reported Approach to Identify Medical Errors and Improve Patient Safety in the Emergency Department.
Medical errors in the emergency department (ED) occur frequently. Yet, common adverse event detection methods, such as voluntary reporting, miss 90% of adverse events. Our objective was to demonstrate the use of patient-reported data in the ED to assess patient safety, including medical errors.



Analysis of patient-reported survey data collected over a 1-year period in a large, academic emergency department. All patients who provided a valid e-mail or cell phone number received a brief electronic survey within 24 hours of their ED encounter by e-mail or text message with Web link. Patients were asked about ED safety-related processes.



From Aug 2012 to July 2013, we sent 52,693 surveys and received 7103 responses (e-mail response rate 25.8%), including 2836 free-text comments (44% of respondents). Approximately 242 (8.5%) of 2836 comments were classified as potential safety issues, including 12 adverse events, 40 near-misses, 23 errors with minimal risk of harm, and 167 general safety issues (eg, gaps in care transitions). Of the 40 near misses, 35 (75.0%) of 40 were preventable. Of the 52 adverse events or near misses, 5 (9.6%) were also identified via an existing patient occurrence reporting system.



A patient-reported approach to assess ED-patient safety yields important, complementary, and potentially actionable safety information.
From the Department of Emergency Medicine, University of North Carolina (UNC) School of Medicine.
Seth W
SW
Glickman
From the Department of Emergency Medicine, University of North Carolina (UNC) School of Medicine.
Abhi
A
Mehrotra
UNC School of Public Health.
Christopher M
CM
Shea
UNC Health Care System, Chapel Hill, NC.
Celeste
C
Mayer
From the Department of Emergency Medicine, University of North Carolina (UNC) School of Medicine.
Jeffrey
J
Strickler
From the Department of Emergency Medicine, University of North Carolina (UNC) School of Medicine.
Sandra
S
Pabers
From the Department of Emergency Medicine, University of North Carolina (UNC) School of Medicine.
James
J
Larson
UNC Health Care System, Chapel Hill, NC.
Brian
B
Goldstein
UNC Health Care System, Chapel Hill, NC.
Larry
L
Mandelkehr
From the Department of Emergency Medicine, University of North Carolina (UNC) School of Medicine.
Charles B
CB
Cairns
Department of Emergency Medicine, The George Washington University, Washington, DC; and the.
Jesse M
JM
Pines
Duke Clinical Research Institute, Duke University, Durham, NC.
Kevin A
KA
Schulman
D000328:Adult; D004636:Emergency Service, Hospital / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D019300:Medical Errors / Q000639:trends*; D008875:Middle Aged; D000071066:Patient Reported Outcome Measures; D061214:Patient Safety / Q000592:standards*; D055815:Young Adult