System contributions to error

An unacceptably high rate of medical error occurs in the emergency departme nt (ED). Professional accountability requires that EDs be managed to system atically eliminate error. This requires advocacy and leadership at every le vel of the specialty and at each institution in order to be effective and s ustainable. At the same time, the significant operational challenges that f ace the ED, such as excessive patient care requirements, should be recogniz ed if error reduction efforts are to remain credible. Proper staffing level s, for example, are an important prerequisite if medical error is to be min imized. Even at times of low volume, however, medical error is probably com mon. Engineering human factors and operational procedures, promoting team c oordination, and standardizing care processes can decrease error and are st rongly promoted. Such efforts should be coupled to systematic analysis of e rrors that occur. Reliable reporting is likely only if the system is based within the specialty to help ensure proper analysis and decrease threat. Ul timate success will require dedicated effort, continued advocacy, and promo tion of research.