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JAMA Intern Med. 2018 Jun 1;178(6):812-819. doi: 10.1001/jamainternmed.2018.0607.

Effect of Systematic Physician Cross-checking on Reducing Adverse Events in the Emergency Department: The CHARMED Cluster Randomized Trial.

Author information

1
Sorbonne Université, Paris, France.
2
Emergency department, Hôpital Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France.
3
Plateforme de recherche clinique (URC-CRC-CRB), Hôpital Saint-Antoine, APHP, Paris, France.
4
Emergency department, Hôpital Cochin, APHP, Paris, France.
5
Emergency department, Hôpital Tenon, APHP, Paris, France.
6
Emergency department, University Grenoble Alps, Hôpital Michallon, Grenoble, France.
7
Emergency department, Hôpital Avicenne, APHP, Paris, France.
8
Emergency department, Hôpital Lariboisière, APHP, Paris, France.
9
Emergency department, Hôpital Européen Georges Pompidou, APHP, Paris, France.
10
Emergency department, Hôpital Saint-Antoine, APHP, Paris, France.
11
Emergency department, Barts Health NHS Trust, London, England.

Abstract

Importance:

Emergency departments (ED) are environments that are at high risk for medical errors. Previous studies suggested that the proportion of medical errors may decrease when more than 1 physician is involved.

Objective:

To reduce the proportion of medical errors by implementing systematic cross-checking between emergency physicians.

Design, Setting, and Participants:

This cluster randomized crossover trial includes a random sample of 14 adult patients (age ≥18 years) per day during two 10-day period in 6 EDs (n = 1680 patients) in France.

Interventions:

Systematic cross-checking between emergency physicians, 3 times a day, which included a brief presentation of one physician's case to another, followed by the second physician's feedback to the first.

Main Outcomes and Measures:

Medical error in the ED, defined as an adverse event (either a near miss or a serious adverse event). The primary end point was identified using a 2-level error detection surveillance system, blinded to the strategy allocation.

Results:

Among the 1680 included patients (mean [SD] age, 57.5 [21.7] years), 144 (8.6%) had an adverse event. There were 54 adverse events among 840 patients (6.4%) in the cross-check group compared with 90 adverse events among 840 patients (10.7%) in the standard care group (relative risk reduction [RRR], 40% [95% CI, 12% to 59%]; absolute risk reduction [ARR], 4.3%; number needed to treat [NNT], 24). There was also a significant reduction rate of near misses (RRR, 47% [95% CI, 15% to 67%]; ARR, 2.7%; NNT, 37) but not of the rate of preventable serious adverse events (RRR, 29% [95% CI, -18% to 57%]; ARR, 1.2%; NNT, 83).

Conclusions and Relevance:

The implementation of systematic cross-checking between emergency physicians was associated with a significant reduction in adverse events, mainly driven by a reduction in near misses.

Trial Registration:

ClinicalTrials.gov Identifier: NCT02356926.

PMID:
29710111
PMCID:
PMC6145759
DOI:
10.1001/jamainternmed.2018.0607
[Indexed for MEDLINE]
Free PMC Article

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