A Patient Reported Approach to Identify Errors & Improve Patient Safety in the ED

Seth W. Glickman, MD, MBA (Bivarus Cofounder), Abhi Mehrotra, MD, Christopher M. Shea, PhD, Celeste Mayer, PhD, Jeffrey Strickler, RN-BC, MA, Sandra Pabers, RN, James Larson, MD, Brian Goldstein, MD, Larry Mandelkehr, MBA, CPHQ, Charles B. Cairns, MD, Jesse M. Pines, MD, MBA, MSCE, and Kevin A. Schulman, MD (Bivarus Cofounder)

Objective: 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.

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

Results: From Aug 2012 to July 2013, we sent 52,693 surveys and received 7,103 responses (e-mail response rate 25.8%), including 2836 free-text comments (44% of respondents). Approximately 242 (8.5%) of 2,836 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 (e.g., 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.

Conclusions: A patient-reported approach to assess ED-patient safety yields important, complementary, and potentially actionable safety information.

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