May 16, 2011 09:00 ET

CRICO/RMF Strategies Convenes Emergency Medicine Leadership Council to Address Crisis in America's Emergency Departments

Collaborative Effort Identifies Communications Breakdowns as Lead Factor in Diagnostic Failure in the ED; Develops Best Practices to Minimize Medical Errors

CAMBRIDGE, MA--(Marketwire - May 16, 2011) - CRICO/RMF Strategies, which is leading an innovative national effort to use malpractice data to help healthcare organizations reduce medical errors and enhance patient safety, announced the findings of a unique collaborative effort of Emergency Department (ED) physicians and nurse leaders who identified and addressed the leading causes of patient errors in EDs.

The effort, conducted by the Emergency Medicine Leadership Council (EMLC) and convened by CRICO and CRICO/RMF Strategies, revealed that communications problems and information gaps between physicians and nurses were a primary driver of diagnostic failure in the ED. According to medical malpractice data from CRICO/RMF Strategies' Comparative Benchmark System (CBS) database, emergency medicine is among the top five areas with the highest malpractice claims and diagnostic failure is the number one cause of medical liability in this area.

Through careful analysis of medical malpractice claims associated with diagnostic failure in the ED, the EMLC discovered that some element of missing information and/or gaps in communication among physicians and nurses were involved in nearly 80% of the cases. Specifically, physicians were often missing essential pieces of information at the time of decision making, which led to misdiagnosis.

Following are key areas of information and/or vulnerabilities affecting information exchange that most often contribute to diagnostic errors in the ED:

  • The availability of prior historical information from the medical record or referring physician,
  • Changes in patient status and/or unresolved abnormal vital signs,
  • The timeliness of laboratory or radiology data,
  • Communication from the consulting physician,
  • Handoffs,
  • Barriers to effective communication between the nurse and physician caring for the patient.

Best Practices to Forge Stronger Physician-Nurse Communication
After identifying these critical areas, the EMLC worked together to develop a set of best practices designed to optimize communication among ED physicians and nurses. These practices, which were field-tested by members of the Council, fall into three primary categories: structured communication events, operational and organizational change, and staff development and education.

Structured communication events, which provide specific prompts or events during the patient's ED visit, facilitate the communications of critical issues and information. An example of this is a Physician-Nurse Huddle, which would take place at either a defined moment in the patient's care to review key information, or at regularly scheduled intervals during the shift. During the huddle, key elements of the patient's course are reviewed and any potential questions clarified.

Operational and organizational change is another process the EMLC developed as a way to facilitate better ED communications. This can include adoption of the LEAN philosophy, wherein processes are standardized as much as possible to eliminate errors, and unnecessary work that does not add value to patient care is eliminated. This approach is borrowed from the manufacturing industry and was established to improve efficiency and reduce wasted time.

Staff development and education that the EMLC recommends is simulation of critical incidents followed by debriefing and reflection, an effective method for practice and an opportunity for team members to improve skills. Simulated incidents allow for practice of skills in a realistic, but low-risk environment. Simulation is of particular value in emergency medicine, as provider teams are rarely if ever constant, due to variable schedules. Simulation scenarios highlight and teach role clarity, leadership skills, effective closed-loop communication, and resource management as teams deliver coordinated care through the exercise.

"The EMLC demonstrates the power of collaboration in addressing pressing medical issues that impact patient safety," said Robert Hanscom, Sr. Vice President of CRICO/RMF Strategies. "This approach was highly effective because it involved a combination of key elements. We began by arming these ED clinicians with medical malpractice 'intelligence' from our database and asked them to assess this data based on their first-hand experience. The group used this information to identify specific issues -- in this case communications problems -- that are at the heart of breakdowns in the patient care process. Then, the group developed and tested best practices within their own hospitals to directly address those areas. The result is a set of real-world practices designed specifically to enhance patient safety and minimize risk in the ED setting."

CRICO/RMF Strategies and the EMLC collaborated on the development of a white paper, which summarizes the initiative's outcome. The paper, "Optimizing Physician-Nurse Communication in the Emergency Department: Strategies for Minimizing Diagnosis-related Errors," can be downloaded at

About the EMLC
The Emergency Medicine Leadership Council (EMLC) is a group of 40 front-line ED physicians and nurse leaders from 19 hospitals across the country that CRICO/RMF Strategies convened for this year-long collaboration. This initiative began when CRICO analyzed data from its Comparative Benchmark System, the largest medical malpractice database in the world, and discovered that Emergency Department medicine was among the top five areas where medical errors most often occur. This data also revealed that diagnostic failure was the number one driver of ED malpractice cases. CRICO/RMF Strategies then formed the EMLC with a focused mission: to identify issues that lead to medical malpractice and pilot solutions in their own practices.

About CRICO/RMF Strategies:
CRICO/RMF Strategies is an innovator that uses medical malpractice data to help hospitals across the nation dramatically reduce medical errors and minimize financial loss. Based on more than 30 years of experience from the Harvard medical community, CRICO/RMF Strategies offers proven methodologies and data-driven insights that reveal hidden areas of risk and deliver actionable intelligence to drive fundamental change that transforms the safety of patient care. The company spearheads a number of leadership initiatives designed to educate and bring the healthcare industry together to improve patient safety. CRICO/RMF Strategies is an operating division of CRICO/RMF, the patient safety and medical malpractice company owned by and serving the Harvard medical community since 1976. For more information, visit

Contact Information

    Dana Siegal, RN, CPHRM
    CRICO/RMF Strategies

    Laura Feng
    Tier One Partners