ED overcrowding is associated with an increased frequency of medication errors

Area of Science:

• Emergency Medicine
• Patient Safety
• Health Services Research

Background:

• Emergency department (ED) crowding is a growing concern with uncertain effects on medication error rates.
• Real-time metrics are needed to assess the impact of crowding on patient safety.

Purpose of the Study:

• To prospectively measure the correlation between ED crowding, using the Emergency Department Work Index (EDWIN) score, and medication errors.
• To evaluate the predictive performance of the EDWIN score for medication errors.

Main Methods:

• Prospective, observational study in a community hospital ED over 3 months.
• ED pharmacists reviewed medication orders for critical care, chest pain unit, and boarding patients.
• Spearman correlation and receiver operating characteristic (ROC) curves were used to analyze data.

Main Results:

• 283 medication errors were identified, including incorrect doses, frequencies, durations, routes, and contraindications.
• A significant positive correlation was found between the average daily EDWIN score and medication error frequency (Spearman's rho = 0.33; P = .001).
• The ROC curve indicated moderate predictive performance for identifying days with >1 medication error.

Conclusions:

• Increased ED crowding, as measured by a real-time modified EDWIN score, is associated with a higher frequency of medication errors.
• This finding underscores the importance of managing ED crowding to enhance patient safety and reduce medication errors.