Medical error and patient safety in the emergency department

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Red flags

• Never alter, delete or back-date the medical record after an error — document contemporaneously, factually and completely; a clearly marked late addendum is permitted, tampering is a regulatory and criminal matter
• Open disclosure must happen promptly after a harmful event — delay, denial or concealment breaches the duty of candour, worsens patient trust and increases litigation
• An apology is not an admission of legal liability — acknowledging harm and saying sorry is the central element of open disclosure and is protected in most jurisdictions
• Root cause analysis asks why, not who — stopping at the active failure (the clinician forgot) and never reaching the latent system cause guarantees the event repeats
• A punitive response to honest error destroys reporting and learning — only reckless conduct warrants sanction, and the just-culture test decides which is which
• The clinician involved in harm is a second victim at high risk of burnout, guilt and post-traumatic stress — peer support, not isolation, is the duty of the department