Management of Multiple Trauma

Promoting patient safety and preventing medical error in emergency departments

An estimated 108,000 people die each year from potentially preventable iatrogenic injury. One in 50 hospitalized patients experiences a preventable adverse event. Up to 3% of these injuries and events take place in emergency departments. With long and detailed training, morbidity and mortality conferences, and an emphasis on practitioner responsibility, medicine has traditionally faced the challenges of medical error and patient safety through an approach focused almost exclusively on individual practitioners. Yet no matter how well trained and how careful health care providers are, individuals will make mistakes because they are human. In general medicine, the study of adverse drug events has led the way to new methods of error detection and error prevention. A combination of chart reviews, incident logs, observation, and peer solicitation has provided a quantitative tool to demonstrate the effectiveness of interventions such as computer order entry and pharmacist order review. In emergency medicine (EM), error detection has focused on subjects of high liability: missed myocardial infarctions, missed appendicitis, and misreading of radiographs. Some system-level efforts in error prevention have focused on teamwork, on strengthening communication between pharmacists and emergency physicians, on automating drug dosing and distribution, and on rationalizing shifts. This article reviews the definitions, detection, and presentation of error in medicine and EM. Based on review of the current literature, recommendations are offered to enhance the likelihood of reduction of error in EM practice.

Objectives to direct the training of emergency medicine residents on off-service rotations: traumatology, Part 1

This is the 30th article in a continuing series of objectives to direct emergency medicine resident experiences on off-service rotations. Because injuries account for tremendous morbidity and mortality, management of trauma is an essential part of training in emergency medicine. Instruction in traumatology during off-service rotations may be conducted at the bedside in difficult and demanding clinical settings. Therefore, it is essential for residents to have specific goals and objectives to guide their acquisition of knowledge required to make rapid, accurate decisions for patients with major trauma.