I’m an emergency physician in Canada with an interest in promoting patient safety through discussing Emergency Room errors and how we as physicians can learn from and prevent them. This website is based on the following principles:
To err is human, especially in the Emergency Room. As emergency physicians, we have little time, scarce information and dwindling resources to make rapid decisions in the management of multiple acute and undifferentiated medical conditions. It’s no surprise that this leads to medical error, but it is surprising how little we talk about it. “Medical error” has been relegated to the private medico-legal realm of shame and punishment–which does little to prevent it–while discussions on Morbidity and Mortality rounds are dominated by rare and unusual cases rather than common and preventable errors. We as a profession should be the first to acknowledge error in its broadest sense–as any hospital/provider factor that results in delayed diagnosis or sub-optimal treatment–and we should have open and collective discussions of how to reduce it. In the section “to ERr is human,” this website aims to normalize the discussion of errors and patient safety in the emergency department.
The ER might be chaotic, but our decision-making models shouldn’t be. Faced with pressures of time and the urgency of medical decisions, we have been taught to approach each chief complaint differently, using a separate set of mnemonics that are often difficult to recall in high-stress situations, and that don’t reinforce an understanding of pathophysiology. This converts chief complaints into fragmented body systems, and leads to a shotgun approach to diagnosis and treatment that increases the risk of error. There is growing awareness of cognitive errors and seeking strategies such as checklists to reduce them, but there is no systematic method designed for Emergency Medicine. In the section “Expanded ABCs,” this website provides a systematic yet streamlined approach to diagnosing, stratifying and treating acute medical emergencies, with a common set up mnemonics that are easy to recall and that help to reinforce pathophysiology and the interconnections of body systems. The section “Approach” provides systematic and streamlined approaches to common chief complaints, integrating recent advances like Point of Care Ultrasound and combining the tasks of resuscitation, investigation and treatment.
The greatest mistake is not learning from our errors and from each other. This website will seek to learn from our errors and discuss how to prevent them: “Literature” will explore what we can learn from published research on misdiagnosis; “Cases” provides lessons from real cases, and “Re-reads” provides examples of ECG and imaging errors; “POCUS” looks at pearls and pitfalls from Point of Care Ultrasound; and “System error” will highlight the funding cuts and other structural issues that put both health providers and patients at risk.