A very scary study has been published in the journal BMC Emergency Medicine. The study found that sixty percent of the causes of unintended incidents in the emergency department that could have compromised patient safety are related to human failures. Human failures mean that the doctors, nurses or even orderlies did do something or did not do something properly.

There is no question that hospitals and emergency rooms are challenging settings with the staff under pressure. However, this can not be an excuse for patients to be made to suffer from unintended harm caused by errors in health care management. Much more effort must be made to eliminate these errors.

Marleen Smits and colleagues from Netherlands Institute for Health Services Research and EMGO Institute for Health and Care Research set out to learn about these accidental causes that result in harm to patients. Their goal was to increase patient safety.

They studied emergency rooms at 10 hospitals in the Netherlands for the limited period of 8-14 weeks. They requested that the emergency room staff report all unintended events, defined as all unintended incidents that could have harmed or did harm a patient.

During this brief period, they received a total of 522 unintended event reports of which more than half had consequences for the patient. A quarter (25%) of the reported events related to cooperation between the emergency department and other hospital departments. The team found that most root causes were human (60%), followed by organizational (25%) and technical (11%). Nearly half of the causes were attributable to departments outside the emergency department, such as the laboratory.

Even if we believe that all events were actually reported (which I believe is unlikely), the high volume of accidental incidents is scary.

The bottom line is that when possible, emergency rooms should be avoided, find an alternative for treatment. Call your doctor and try to get them to see you in their office or at your home. The number of errors is too high, we should not be at this level of risk. Going to an emergency room not only exposes you to other people’s illnesses, takes an intolerable amount of time, but also can put your life at risk. Just think, you actually pay for this!

Journal reference:
1. Marleen Smits, Peter P Groenewegen, Danielle RM Timmermans, Gerrit van der Wal and Cordula Wagner. The nature and causes of unintended events reported at ten emergency departments. BMC Emergency Medicine, 2009; (in press)

Joel T Nowak MA, MSW