Emergency rooms are pressure cookers. Quick decisions have to be made and the relentless triage is not always pretty.
But there's a difference between quick decisions and cold assessments, which are unavoidable, and outright medical errors that cause injuries and deaths.
A particularly galling aspect of this problem is the increasing use of temporary staff in the ER. According to a recent study by researchers at Johns Hopkins University, the use of temporary doctors and nurses in emergency departments raises the risk of medical mistakes - particularly medication errors.
Research Findings on ER Errors
The Johns Hopkins study analyzed almost 24,000 cases of medication errors in emergency rooms in 592 hospitals. It covered the years between 2000 and 2005.
The study found that temporary doctors and nurses were twice as likely as permanent emergency room staff to be associated with medication errors that injured patients. The researchers surmised that this may be because the temps lack familiarity with a given hospital's established systems and best practices.
"You may know the medicine," said one of the researchers, Dr. Julius Cuong Pham of Johns Hopkins University School of Medicine. "[B]ut you still may get tripped up by the policies and procedures of an unfamiliar system. This can lead to more serious errors."
In other words, the study's finding should not be interpreted as a blame game aimed at temporary doctors and nurses. Rather, the study could be seen as a wakeup call about the problems with making the profit motive primary in the delivery of health care services.
After all, temporary workers tend to come cheaper than permanent staff. The wages and above all the benefits tend to be significantly less for temps than for those whose jobs are more permanent. The Johns Hopkins study documenting the increased risk of errors associated with temps suggests the truth of the old adage: you get what you pay for.
How Systemic Causes Produce Specific Errors
The profit motive may not be the only underlying cause of elevated risk of ER errors. There is also the issue of the overall management record of the hospital itself.
"A place that uses a lot of temporary staff may have more quality of care issues in general," observed Dr. Pham. "It may not be the temporary staff that causes those errors but a function of the whole system."
To acknowledge these systemic issues is not to absolve individual doctors or nurses of responsibility for mistakes they may make. A mistake like leaving a surgical sponge inside a patient after an operation is a mistake by any definition.
But the practice of medicine in today's complex, highly specialized health care system is also inherently a highly collaborative act. In such a system, medical mistakes do not just involve lone-wolf doctors dropping the ball; they involve intricate systems of service delivery that can get out of whack when poor management decisions are made.
Temporary Nurses Becoming More Common
One such management decision that has to be questioned, in light of the Johns Hopkins study, is the growing use of temporary nurses. This is true not only in the emergency room, but across the healthcare system.
There are several reasons for the increased use of temporary nurses. One is the fact that there is a nursing shortage in the U.S. Another is that temp nurses are widely seen by hospital administrators as a cheap alternative to permanent nurses.
Efficiency is one thing. In such tough economic times, health care systems, like everyone else, must look to cut costs where they safely can. This should not be done, however, if the supposed efficiencies end up compromising patient care.
Or, to put it more bluntly, hospitals shouldn't try to cut costs so aggressively that patients end up getting hurt by medical malpractice.
Preventing Emergency Room Errors
This reasoning clearly applies to emergency room errors. Serving patients in the ER is already challenging, because of the immediate urgency of the patients' needs. That challenge should not be compounded by staffing the ER with too many doctors and nurses who are unfamiliar with a hospital's systems. The combination of the patients' urgency and the providers' unfamiliarity is a recipe for trouble that should be avoided.
