Abstract. Objectives: To evaluate the error management systems emergency medicine residency directors (EMRDs) use to identify and report clinical errors made by emergency medicine residents and their satisfaction with error-based teaching as an educational tool. Methods: All 112 EMRDs listed by the Accreditation Council for Graduate Medical Education in 1996 were sent a 15-item survey. Five areas of error evaluation and management were assessed: 1) systems for tracking and reporting clinical errors; 2) resident participation in the systems; 3) resident remediation; 4) EMRD-perceived satisfaction with current error-reporting mechanisms, their educational value, and their ability to identify and prevent errors; and 5) EMRDs' perceptions of faculty and resident satisfaction with the systems. Results: The response rate was 86%. All EMRDs indicated that methods are in place to track and report errors at their institutions. These include morbidity and mortality conference (94%), quality assurance case review conference (76%), and continuous quality improvement audits (60%). A majority of programs (58%) present resident cases anonymously in order to enhance teaching (39%), to avoid embarrassment (28%), and to avoid individual blame (24%). While mandated resident remediation is not required at 48% of the programs, 24% require lectures, 17% require written reports, and 6% require extra clinical shifts. The EMRDs rated the educational value of morbidity and mortality conference as outstanding (11%) or excellent (53%), and rated their systems for identifying key resident errors as outstanding (0%), excellent (14%), or good (47%). Conclusions: All emergency medicine residency programs have systems to track and report resident errors. Resident participation varies widely, as does resident remediation processes. Most EMRDs are satisfied with their systems but few EMRDs rate them as excellent in the detection or prevention of clinical errors. Key words: education; quality assurance; clinical operations. ACADEMIC EMERGENCY MEDICINE 2000; 7:1317-1320 C LINICAL error in medical practice is a wellrecognized phenomenon. Previous studies of inpatient services in major teaching hospitals suggest that 3.7% to 38% of hospitalized patients suffer from an adverse iatrogenic event or illness. 1-3Many of these iatrogenic events were caused by preventable errors.1,2 Although much has been written on errors in medicine, 1-17 most studies have focused on adverse patient outcomes, 1-5 increased medical cost, 6,7 and the legal implications of such error.8 Little attention has focused specifically on resident error educational systems.9 For resident physicians in training, errors can become 10 Resident errors provide skillful medical educators with a unique teaching tool; however, little is know about how these errors are used in an educational format. To the best of our knowledge, no previous study has investigated how emergency medicine (EM) residency programs track and report clinical errors made by their residents.The objective of this study...

Summaryobjectives To identify case management, health system and antimalarial drug factors contributing to malaria deaths.method We investigated malaria-related deaths in South Africa's three malaria endemic provinces from January 2002 to July 2004. Data from healthcare facility records and a semi-structured interview with patients' contacts were reviewed by an expert panel, which sought to reach consensus on factors contributing to the death. This included possible health system failures, adverse reactions to antimalarials, inappropriate medicine use and failing to respond to treatment.results Approximately 177 of 197 cases met inclusion criteria for the study. Delay in seeking formal health care was significantly longer for patients who sought traditional health care [median 4; interquartile range (IQR) 3-7 days] than for patients who did not (median 3; IQR 1-5 days; P ¼ 0.033).Patients with confirmed or suspected HIV/AIDS were significantly more likely to use traditional approaches (25%) than those with other comorbidities (0%; P ¼ 0.002). Malaria was neither suspected nor tested for at a primary care facility in 23% of cases with adequate records. Initial hospital assessment was considered inadequate in 74% of cases admitted to hospital and in-patient monitoring and management was adequate in only 27%. There were 32 suspected adverse reactions to antimalarial therapy.conclusion A confidential enquiry into malaria-related deaths is a useful tool for identifying preventable factors, health system failures and adverse events affecting malaria case management.

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Objective: To determine whether shorter compression durations combined with fixed increased compression velocity during mechanical highimpulse CPR (HI-CPR) improve resuscitation hemodynamics, compared with mechanical standard CPR (SCPR).Methods: A porcine model of vkntricular fibrillation was used, with each animal serving as its own control. Twelve anesthetized swine (20-25 kg each) were instrumented for hemodynamic monitoring. Ventricular fibrillation was induced and followed, after 3 minutes, by mechanical SCPR (50% duty cycle) for 10 minutes. Mechanical HI-CPR was then applied, with compression durations varied randomly at 2-minute intervals for 20% (COM20). 30% (COM30), and 40% (COM40) of the CPR cycle. A 2-n~inute mechanical SCPR control phase completed the experiment.Results: Hemodynamic measurements were significantly better for COM20 and COM30 vs SCPR. including, respectively: mean arterial pressure (MAP), 45 k 8 and 43 ? 7 vs 36 k 7 torr; coronary perfusion pressure (CPP), 21 ? 6 and 21 ? 8 vs 16 2 6 torr; and end-tidal CO, (ETCO,), 7 5 2 and 6.6 L 2 vs 5 k 1.4 torr. MAP, CPP, and ETCO, during COM40 were not significantly different from those during SCPR, and there was no difference between COM20 and COM30 for any hemodynamic parameter. Aortic flow velocity was significantly better in COM20, COM30, and COM40 vs SCPR: 2.3 t 0.7, 2.1 2 0.9, and 1.95 2 0.9 vs 1.3 ? 0.5 crn/sec, respectively. Conclusion:In a swine model of mechanical HI-CPR, shorter compression durations combined with fixed increased compression velocity significantly improve resuscitation hemodynamics, compared with those afforded by mechanical SCPR. Acad. Emerg. Med. 1994; 11430-437.