Error Identification, Disclosure, and Reporting: Practice Patterns of Three Emergency Medicine Provider Types

Objectives: To gather preliminary data on how the three major types of emergency medicine (EM) providers, physicians, nurses (RNs), and out-of-hospital personnel (EMTs), differ in error identification, disclosure, and reporting. Methods: A convenience sample of emergency department (ED) providers completed a brief survey designed to evaluate error frequency, disclosure, and reporting practices as well as error-based discussion and educational activities. Results: One hundred sixteen subjects participated: 41 EMTs (35%), 33 RNs (28%) and 42 physicians (36%). Forty-five percent of EMTs, 56% of RNS, and 21% of physicians identified no clinical errors during the preceding year. When errors were identified, physicians learned of them via dialouge with RNs (58%), patients (13%), pharmacy (35%), and attending physicians (35%). For known errors, all providers were equally unlikely to inform the team caring for the patient. Disclosure to patients was limited and varied by provider type (19% EMTs, 23% RNs, and 74% physicians). Disclosure education was rare, with ≤15% of any provider type receiving such instruction. Yet, 59% of physicians had observed another provider disclose an error to a patient. Error discussions are widespread, with all providers indicating they discussed their own as well as the errors of others. Conclusions: This study suggests that error identification, disclosure, and reporting challenge all members of the ED care delivery team. Provider-specific education and enhaned teamwork training will be required to further the transformation of the ED into a high-reliability organization.