EP performance was superior at identifying severe ADREs relating to the patients' chief complaints. However, EP performance was suboptimal with respect to identifying ADREs of lower severity, having missed a significant number of ADREs of moderate severity as well as ones unrelated to the patients' chief complaints. ADRE detection methods need to be developed for the ED to aid EPs in detecting those ADREs that are most likely to be missed.

Objectives: The authors examined the ability of emergency physicians (EPs) to recognize adverse drug-related events (ADREs) in elder patients presenting to the emergency department (ED). Methods: This was a prospective observational study of patients at least 65 years of age who presented to the ED. ADREs were identified using a validated, standardized scoring system. EP recognition of ADREs was assessed through physician interview and subsequent chart review. Results: A total of 161 patients were enrolled in the study. Thirty-seven ADREs were identified, which occurred in 26 patients (16.2%; 95% confidence interval [CI] = 10.5% to 22.0%). The treating EPs recognized 51.2% (95% CI = 35.2% to 67.4%) of all ADREs. There was better recognition of those ADREs related to the patient's chief complaint (91%; 95% CI = 74.1% to 100%) as compared with recognition of ADREs that were not associated with the chief complaint (32.1%; 95% CI = 14.8% to 49%). EPs recognized six of seven severe ADREs (85.7%), 13 of 23 moderate ADREs (56.5%; 95% CI = 36.8% to 77%), and none of the mild ADREs. Recognition of ADREs varied with medication class. Conclusions: EP performance was superior at identifying severe ADREs relating to the patients' chief complaints. However, EP performance was suboptimal with respect to identifying ADREs of lower severity, having missed a significant number of ADREs of moderate severity as well as ones unrelated to the patients' chief complaints. ADRE detection methods need to be developed for the ED to aid EPs in detecting those ADREs that are most likely to be missed. Key words: emergency department; adverse drug-related events; drug-related morbidity; physician performance. ACADEMIC EMERGENCY MEDICINE 2005; 12:197-205. Adverse drug-related events (ADREs) are unfavorable medical events related to the use and misuse of overthe-counter and prescription medications. ADREs have emerged as important health risks, especially in elders, who tend to consume the most medications. ADREs may account for up to 28% of emergency department (ED) visits 1-3 and 30% of hospital admissions 4-6 and significantly inflate hospital expenditures. In 1998, ADREs were identified as the sixth leading cause of in-hospital mortality in the United States. 7,8 In an attempt to reduce drug-related morbidity and mortality, researchers have begun to study clinicians' ability to detect and treat ADREs. Large-scale studies have shown that clinicians taking care of inpatients detect only 5%-15% of drug-related events in hospitals without systematic surveillance systems.9,10 In contrast, reports from intensive care settings indicate that the presence of a pharmacist on rounds decreases the rate of preventable ADREs by helping intercept errors as well as unrecognized events.11 These studies have served as the basis for justifying the cost of a pharmacist present on intensive care unit and medical ward rounds in many institutions.The few published studies that have documented the significance of ADREs in the ED setting 1-3,12 have not

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