Do No Harm? Medical Errors in Emergency Care and Beyond

Academic Emergency Medicine (AEM), the peer-reviewed journal of the Society for Academic Emergency Medicine, has published its March issue dedicated to the topic of errors in emergency care, with a strong emphasis on diagnostic error. This special issue, supported by the Agency for Healthcare Research and Quality (AHRQ), brings together leading scholars and clinicians to discuss aspects of errors relevant to emergency care and propose actionable solutions.

Following the landmark 2015 National Academies report, “Improving Diagnosis in Healthcare,” national awareness of diagnostic errors has increased significantly.   Errors—ranging from missed, incorrect, or delayed diagnoses—are recognized as universal issues across all medical specialties, with emergency medicine being particularly vulnerable due to its high-pressure, resource-limited environment. 

Errors extend beyond missed or delayed diagnoses to botched surgeries, failures to order or act on critical lab work, applying the wrong treatments, prescribing wrong medications and ignoring patient’s symptoms or concerns also among the top 10 medical errors.

Medical errors are a leading cause of patient morbidity and mortality. A 2016 mortality analysis ranked medical errors as the third major cause of death in the U.S., following heart disease and cancer, which were ranked on the first and second place, respectively. A meta-analysis published in 2019 of 70 studies involving a total of 337,025 patients revealed that the average rate of preventable patient harm was 6%, of which 12% was severe or led to death.

This special issue of AEM features a comprehensive examination of many of these challenges. Topics are organized according to themes, such as the role of cognitive processing in doctors and nurses, flawed communication, potential errors of omission, specific conditions, and a special contribution on the potential role of artificial intelligence to reduce error. I’m all for anything that helps

AEM Editor-in-Chief Jeffrey A. Kline, MD, said that the special issue offers valuable insights, with a key takeaway that a need exists to move beyond blame and individual fault.

I do not agree with that takeaway. Perpetrators should not be held blameless or concealed within major medical systems.  I do agree with him that  “. . . we must recognize errors as complex, often arising from a convergence of factors—including gaps in knowledge and communication, inadequate awareness, and various system-based challenges.”