"Crossing the Quality Chasm" in Emergency Medicine

The emergency department (ED) provides an important portal in the health care system for many patients, especially for some of our most vulnerable patients.The high volume and high complexity of emergency practice create an environment that is prone to errors and quality concerns.The lack of continuity with patients, coupled with an inadequate information infrastructure for care across the continuum, often forces emergency providers to see patients without all the information needed to make cost-effective, high-quality decisions.In this paper, I discuss the important role of EDs in improving patient safety and health care quality, as well as how emergency medicine can respond to the recent Institute of Medicine (IOM) report, ''Crossing the Quality Chasm.'' 1 Finally, I discuss new and emerging issues for ED quality and the implications for health services researchers within emergency medicine.Much of the attention on patient safety followed the release of the IOM report, ''To Err Is Human: Building a Safer Health System.'' 2 Using data from several large studies of medical injury, the report estimated between 44,000 and 98,000 deaths per year from medical injury.In human terms, this would rank medical errors as the eighth leading cause of death.And in terms of cost, it would result in $17-29 billion in excess cost.The IOM used the following definition of errors: an error is defined as the failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim.Errors can include problems in practice, products, procedures, and systems.A final and important conclusion of the report was that health care must begin to learn from other industries.Though it is often difficult to get the attention of Dr. Burstin is the Director of the Center for Primary Care Research at the Agency for Healthcare Research and Quality of the U.S. Department of Health and Human Services.