Krug, S. E.Frush, K.
 Patient safety in the pediatric emergency care setting.
Pediatrics. 2007 Dec;120:1367-1375.
This policy statement from the American Academy of Pediatrics focuses on patient safety in the emergency department. It delineates specific suggestions and guidelines for reducing medication errors and enhancing patient safety for children. These include practices such as time-outs before procedures, mock codes, teamwork training, use of clinical tools to aid medication dosing and administration, integrating family-centered care into the ED, and supporting Institute of Medicine recommendations.
Rodriguez, R. M., Anglin, D., Hankin, A., et al.
A longitudinal study of emergency medicine residents' malpractice fear and defensive medicine.
Acad Emerg Med. 2007 Jun;14:569-573.
Using case scenarios in a prospective, longitudinal study of emergency medicine residents at 5 programs, these authors sought to evaluate residents' evolution of defensive medicine and malpractice concern. 46 residents were evaluated during the course of their residency. Interns were found to enter programs with a "moderate" malpractice concern, which did not change significantly during the course of the residency. These concerns did not markedly impact their decisions to perform ED procedures.
Ritsema TS, Kelen GD, Pronovost PJ et al.
The National Trend in Quality of Emergency Department Pain Management for Long Bone Fractures
Acad Emerg Med. 2007 Feb;14:163-169.
Although pain management continues to receive national attention, it is unclear how the JCAHO 2001 standards have impacted this important area. This is a retrospective study of the National Hospital Ambulatory Medical Care Survey (NHAMCS), comparing pain management for long bone fractures for the period before, and after, the new standards were implemented. Overall, analgesic use for this population increased from 56% to 76%, and opiate use increased from 50% to 56%. It appears that while there are increases in use of analgesics, there is still significant room for improvement.
Kachalia A, Gandhi TK, Puopolo AL et al.
Missed and delayed diagnoses in the emergency department: a study of closed malpractice claims from 4 liability insurers
Ann Emerg Med. 2007 Feb;49:196-205.
Mistaken or delayed diagnoses contribute significantly to ED malpractice claims. This study looked at 79 closed ED malpractice claims to discern attributes and patterns leading to risk. Forty-eight percent of cases were associated with serious harm, with 39% resulting in death. Most diagnostic failures were the result of multiple contributing factors. Of note, the leading factors contributing to missed diagnoses were: cognitive factors (96%), patient related factors (34%), lack of appropriate supervision (30%), inadequate handoffs (24%), and excessive workload (23%).
National Report Card on the State of Emergency Medicine
American College of Emergency Physicians, 2006
The American College of Emergency Physicians has published a report that looks at the support each state provides for emergency care, offering a letter "grade" for each state, with an overall national average of C minus. Measures were broken into 4 broad categories: access to emergency care, quality and patient safety, medical liability issues, and public health and injury prevention. The report highlights the increasing pressure on our emergency care system, with the closing of 15% of EDs over the past decade and continually increasing volume. You can learn more and see information for any state by going to the link provided.
Hunt EA, Hohenhaus SM, Luo X
Simulation of pediatric trauma stabilization in 35 North Carolina emergency departments: identification of targets for performance improvement.
Pediatrics. 2006 Mar;117(3):641-648.
This prospective, observational study looked at pediatric trauma mock codes at 35 North Carolina EDs, scoring each code on 44 stabilization tasks. While the median number of tasks that needed improvement was 25 (57%), some common critical tasks, such as warming measures, ordering IV fluids and preparing for intraosseous needle insertion, were missed by the vast majority. Their conclusion suggests that mistakes in handling pediatric trauma are very common and that additional training is needed to enhance outcomes for pediatric patients.
 2005 National Healthcare Quality Report
U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality
This report is a national overview of the quality of healh care in the United States. It reviews four dimensions of quality- effectiveness, patient safety, timeliness, and patient centeredness. Although not focused on emergency departments, the report suggests that while overall quality is improving in many areas, emergency departments are not doing as well. Examples cited include increasing "left without being seen rates" (1.2% in 1997-98 to 1.7% in 2001-02) and longer than desired (and unchanging) "time to initiation of thrombolytic therapy" of about 45 minutes.
Gausche M, Rutherford M, Lewis RL.
Emergency department quality assurance/improvement practices for the pediatric patient.
Ann Emerg Med. 1995 Jun;25(6):804-8.
Outlines need for separate QI program for children in general emergency departments.
| 
