Cross-Checking between ED Physicians Reduces Harm

A new study suggests that systematic cross-checking between doctors may be a key to reducing the high rate of adverse events in the emergency department (ED).

Researchers at the Sorbonne University (Paris, France), Pitie-Salpetriere Hospital (Paris, France), and other institutions conducted a cluster randomized crossover trial that included a random sample of 1,680 patients attended to in six EDs in France during two 10-day periods. The intervention included systematic cross-checking between ED physicians three times a day, which included a brief presentation of one physician’s case to another, followed by the second physician’s feedback. The main outcome was medical error, defined as either a near miss or a serious adverse event.


The results showed that there were 54 adverse events among 840 patients (6.4%) during the cross-check intervention, compared with 90 adverse events among 840 patients (10.7%) during the control period, a relative reduction of 40%. Most of the reductions occurred in adverse events defined as near misses, with a reduction of 47%. Errors in sepsis management accounted for more than 40% of the preventable serious adverse events. The median duration of cross-checking sessions was nine minutes, during which about seven patients were discussed. The study was published on April 23, 2018, in JAMA Internal Medicine.

“The reduction in preventable serious adverse events with systematic cross-checking did not reach statistical significance; only reductions in near misses did,” explained lead author Yonathan Freund, MD, PhD, of Hôpital Pitié-Salpêtrière. “Whether an adverse event resulted from a misdiagnosis or from the implementation of an inappropriate plan for the correct diagnosis could not be determined decisively. This included sepsis-associated medical errors, which may be particularly relevant, because the most commonly occurring serious adverse events were violations of the surviving sepsis campaign guidelines.”

An adverse event is defined as a preventable or non-preventable injury that was caused by medical management (rather than the underlying disease) and that prolonged hospitalization, produced a disability at the time of discharge, or both. Adverse event also include errors, defined as acts of commission or omission leading to an undesirable outcome or significant potential for such an outcome, and near misses, in which an error was committed, but the patient did not experience clinical harm, either through early detection or sheer luck.

Related Links:
Sorbonne University
Pitie-Salpetriere Hospital