Physician cross-checking reduces patient harm in ED

To reduce high rates of adverse events in the emergency department, emergency physicians may look to systematic cross-checking to reduce the risk of patient harm, according to a study published in JAMA Internal Medicine.

"In the ED, the care of a patient is often managed by a sole physician," the study authors wrote, as cited by a post in The American Journal of Managed Care. "This contrasts with other clinical settings in which patients may benefit from multiple ward rounds, staff meetings and handovers."

Here are seven things to know about the study.

1. The researchers performed a cluster-randomized crossover trial of 1,680 patients from six EDs over two periods of 10 days that were a month apart. During the first 10-day period, the researchers assigned each ED to either the intervention or control group. To compare, during the second period, the researchers applied the other strategy to each ED.

2. The EDs implemented a systematic cross-checking between emergency physicians three times a day. The cross-checking consisted of a brief presentation from one physician on the patient's sex, age, chief complaint, main medical history, main clinical findings, treatment provided in the ED and summary of the care plan. The second physician then provided feedback.

3. During the intervention period, there were 382 cross-checking sessions. The intervention period identified 573 patients (68 percent) who were cross-checked. The median duration of sessions was nine minutes. A median number of seven patients were cross-checked during each session.

4. Out of the 1,680 patients, 144 (8.6 percent) had an adverse event. The study revealed 54 adverse events among 840 patients (6.4 percent) who were cross-checked, as opposed to 90 adverse events among 840 patients (10.7 percent) in the standard-care group. The study found a relative risk reduction of 40 percent in adverse event rates.

5. Patients benefit from systematic cross-checking because it allows them to receive an opinion from a second physician, according to the researchers. Additionally, implementing checklists was reported to reduce the rate of medical error.

6. "It is likely that systematic cross-checking reduced the rate of adverse events errors by allowing a reevaluation of the patient by the peer cross-checker, who is able to cast a fresh eye on the patient's management," the authors wrote. "Moreover, the cross-checks may have forced the physician to reconsider his or her initial diagnosis and management plan and, in turn, intercept an error."

7. However, due to the retrospective nature of the analysis, it was difficult to identify the exact nature of the error that led to an adverse event, the researchers noted.

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