Most ED patients feel safe, but many fear errors

Misdiagnosis, medication errors are top concerns

A new study published in the journal Academic Emergency Medicine contains good news and bad news for ED managers. The good news: In a survey of 767 patients from 12 EDs, most individuals surveyed (88%) believed their safety from medical errors had been good, very good, or excellent.

However, 38% of them reported experiencing at least one specific error-related concern, with the most common concerns being misdiagnosis (22% of all patients), physician error (16%), and medication error (16%).1

"I was pleased to see the majority of patients actually did feel they were not at high risk for medical errors; it’s actually a greater number than I would have guessed," explains Linda Laskowski Jones, RN, MS, APRN, BC, CCRN, CEN, director of trauma, emergency, and aeromedical services at Christiana Hospital in the Christiana Care Health System in Newark, DE.

While most patients believe hospitals are doing a good job managing these concerns, ED managers need to recognize that medical errors are real issues to patients, says Thomas E. Burroughs, PhD, associate professor at St. Louis University Center for Outcomes Research and lead author of the study.

"Emergency department personnel need to recognize that during the course of care, patients experience concerns about specific impending medical errors — some of which may be associated with actual errors," he notes.

Involvement eases concerns

There are several strategies ED managers can adopt to ease these concerns, and the most important one is to involve patients more directly in their own care, Laskowski Jones says.

"The first and foremost thing is to stress to your staff that they have to keep the patient informed — to make them part of the team," she asserts.

"If they know their plan of care, and something does not go according to that plan, either they or a family member can raise a concern." For example, Laskowski Jones notes, patients can offer an additional check on whether they are being given the proper medications or having the right part of their body X-rayed.

"In a culture of safety, the manager must hold staff accountable for keeping patients informed," she says. "That’s key."

Burroughs agrees. "By directly involving patients in their own care, and encouraging them to inform their providers of any signs of errors, the level of safety can be elevated for all emergency department patients," he says.

As part of the safety culture, the ED staff at Christiana Hospital also pay close attention the Joint Commission on Accreditation of Healthcare Organizations’ 2005 National Patient Safety Goals, Laskowski Jones points out.

"The nurse manager can audit the compliance of staff, whether self-reported or directly, and in instances that need follow-up, look at work-flow processes and individual employee behavior to address issues that need to be corrected," she advises.

While Laskowski Jones hasn’t done it yet, she adds that it probably would be a good idea to have the goals written out and given to the patients.

"You could say, These are important safety goals, and we are committed to them,’" she offers. "It would be a nice, innovative approach, and whenever you build patients into the care process, they will feel more comfortable."

And patients who feel comfortable can mean dollars in your pocket, says Burroughs. "The occurrence of a single error-related concern — not necessarily an actual error — was enough to have a significant impact on a patient’s willingness to recommend and return to the facility for future care," he observes.


1. Burroughs, et al. Patient concerns about medical errors in emergency departments. Acad Emerg Med 2005; 12:57-64.


For more information on reducing ED patients’ concerns, contact:

  • Thomas E. Burroughs, PhD, St. Louis University Center for Outcomes Research, Salus Center, Second Floor, 3545 Lafayette Ave., St. Louis, MO 63104. Fax: (314) 977-1101. E-mail:
  • Linda Laskowski Jones, RN, MS, APRN, BC, CCRN, CEN, Director, Trauma, Emergency, and Aeromedical Services, Christiana Hospital, Christiana Care Health System, Newark, DE. Phone: (302) 733-1835. E-mail: