@article{1193,
  author = {Yonathan Freund and Hélène Goulet and Judith Leblanc and Jérôme Bokobza and Patrick Ray and Maxime Maignan and Sabine Guinemer and Jennifer Truchot and Anne-Laure Féral-Pierssens and Youri Yordanov and Anne-Laure Philippon and Edwin Rouff and Ben Bloom and Marine Cachanado and Alexandra Rousseau and Tabassome Simon and Bruno Riou},
  title = {Effect of Systematic Physician Cross-checking on Reducing Adverse Events in the Emergency Department: The CHARMED Cluster Randomized Trial.},
  abstract = {<p><b>Importance: </b>Emergency departments (ED) are environments that are at high risk for medical errors. Previous studies suggested that the proportion of medical errors may decrease when more than 1 physician is involved.</p><p><b>Objective: </b>To reduce the proportion of medical errors by implementing systematic cross-checking between emergency physicians.</p><p><b>Design, Setting, and Participants: </b>This cluster randomized crossover trial includes a random sample of 14 adult patients (age ≥18 years) per day during two 10-day period in 6 EDs (n = 1680 patients) in France.</p><p><b>Interventions: </b>Systematic cross-checking between emergency physicians, 3 times a day, which included a brief presentation of one physician's case to another, followed by the second physician's feedback to the first.</p><p><b>Main Outcomes and Measures: </b>Medical error in the ED, defined as an adverse event (either a near miss or a serious adverse event). The primary end point was identified using a 2-level error detection surveillance system, blinded to the strategy allocation.</p><p><b>Results: </b>Among the 1680 included patients (mean [SD] age, 57.5 [21.7] years), 144 (8.6%) had an adverse event. There were 54 adverse events among 840 patients (6.4%) in the cross-check group compared with 90 adverse events among 840 patients (10.7%) in the standard care group (relative risk reduction [RRR], 40% [95% CI, 12% to 59%]; absolute risk reduction [ARR], 4.3%; number needed to treat [NNT], 24). There was also a significant reduction rate of near misses (RRR, 47% [95% CI, 15% to 67%]; ARR, 2.7%; NNT, 37) but not of the rate of preventable serious adverse events (RRR, 29% [95% CI, -18% to 57%]; ARR, 1.2%; NNT, 83).</p><p><b>Conclusions and Relevance: </b>The implementation of systematic cross-checking between emergency physicians was associated with a significant reduction in adverse events, mainly driven by a reduction in near misses.</p><p><b>Trial Registration: </b>ClinicalTrials.gov Identifier: NCT02356926.</p>},
  year = {2018},
  journal = {JAMA Intern Med},
  volume = {178},
  pages = {812-819},
  month = {12/2018},
  issn = {2168-6114},
  doi = {10.1001/jamainternmed.2018.0607},
  language = {eng},
}