Emergency. 2018; 6 (1): e33

LE T T E R TO ED I TO R

Medical Errors in Emergency Department; a Letter to Edi-
tor
Payman Asadi1∗, Ehsan Modirian2, Nazanin Dadashpour1

1. Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran.

2. Emergency Department, Qazvin University of Medical Sciences, Qazvin, Iran.

Received: April 2018; Accepted: May 2018; Published online: 21 May 2018

Cite this article as: Asadi P, Modirian E, Dadashpour N. Medical Errors in Emergency Department; a Letter to Editor. Emergency. 2018; 6(1):

e33.

Dear Editor:
Medical error is the third leading cause of death in the United

States of America and almost 100000 patients lose their life

due to medical errors every year (1).

Studies show that the number of medical errors is increas-

ing annually. Various factors such as weak communication

between medical staff and patients, the activity of the press

and other mass media, insurance companies, lawyers and le-

gal advisers, reposition of the doctors, economic problems of

the health care team, and etc. have an important role in this

increasing trend (2-5).

Medical errors are generally considered from two perspec-

tives, which include individual approach (traditional) and

systemic approach (holistic).

In individual approach the initial encounter with an error is

finding the guilty person and blaming him/her. In this ap-

proach, each individual is responsible for their actions, indi-

vidually. This approach has a long background in the world

of medicine and aims to improve performance with actions

like compulsory education, warning, legislation, and punish-

ment. The problem of this approach is that the system is ig-

nored, so it does not reduce medical errors, because the er-

ror is influenced by several factors; therefore, blame or even

abandoning those who are guilty does not change anything.

The systemic approach is an unavoidable phenomenon that

can be used to enhance the performance of the system. Ac-

tually systemic approach is to change the system, so that the

probability of error is reduced. When an undesirable event

occurs is not important to find out who has made a mistake,

but we must examine what has caused the failure of defense

mechanisms against errors. System sets of elements (human

∗Corresponding Author: Payman Asadi; Road trauma Research Center,
Poursina Hospital, Rasht, Guilan Province, Iran. Tel: +989111351340; Fax:
+983117923445; Email: payman.asadi@yahoo.com

and inhuman) are independent and interact with each other

to achieve a common objective. Man acts as a part of the sys-

tem and the last of the cycle and the final performer of the

system. For this reason, root causes of medical errors should

be managed.

Overcrowding, shortage of personnel and equipment, and

admission of patients with life-threatening diseases has

made the emergency departments prone to higher incidence

of medical errors.

Poursina Hospital is an educational Hospital in Rasht, Guilan

province, North Iran, with about 30000 to 35000 admissions

per year. Performing a cross sectional study, we analyzed the

registered cases of medical errors in the hospital during one

year. 396 (1.24%) cases of medical errors were reported and

emergency department with 134 (33.7%) cases had the high-

est incidence of medical errors among hospital wards. Di-

agnostic errors with 173 (43.5%) cases and medication errors

with 100 (25.1%) were among the most common reported er-

rors. Most of the people were not informed regarding their

error and there was the possibility that they repeat the same

errors.

It seems that experienced personnel should be used to re-

duce the occurrence of medical errors in the crowded wards,

which have to support patients with life-threatening dis-

eases. People should be aware that the error registry system

has been launched to identify and resolve system errors and

it doesn’t aim to identify the offender.

1. Appendix

1.1. Acknowledgements

None.

1.2. Author’s contribution

All the authors of this article met the criteria of authorship

based on the recommendations of the international commit-

This open-access article distributed under the terms of the Creative Commons Attribution NonCommercial 3.0 License (CC BY-NC 3.0).
Downloaded from: www.jemerg.com



P. Asadi et al. 2

tee of medical journal editors.

1.3. Conflict of interest

Hereby, the authors declare that there is no conflict of interest

regarding the present study.

1.4. Funding and support

None.

References

1. Donaldson MS, Corrigan JM, Kohn LT. To err is human:

building a safer health system: National Academies Press;

2000.

2. Schenkel S. Promoting patient safety and preventing med-

ical error in emergency departments. Academic Emer-

gency Medicine. 2000;7(11):1204-22.

3. Sandars J, Esmail A. The frequency and nature of medical

error in primary care: understanding the diversity across

studies. Family practice. 2003;20(3):231-6.

4. Schwappach DL, Koeck CM. What makes an error unac-

ceptable? A factorial survey on the disclosure of medi-

cal errors. International Journal for Quality in Health Care.

2004;16(4):317-26.

5. Tamuz M, Thomas E, Franchois K. Defining and classify-

ing medical error: lessons for patient safety reporting sys-

tems. BMJ Quality & Safety. 2004;13(1):13-20.

This open-access article distributed under the terms of the Creative Commons Attribution NonCommercial 3.0 License (CC BY-NC 3.0).
Downloaded from: www.jemerg.com


	Appendix
	References