System contributions to error.

An unacceptably high rate of medical error occurs in the emergency department (ED). Professional accountability requires that EDs be managed to systematically eliminate error. This requires advocacy and leadership at every level of the specialty and at each institution in order to be effective and sustainable. At the same time, the significant operational challenges that face the ED, such as excessive patient care requirements, should be recognized if error reduction efforts are to remain credible. Proper staffing levels, for example, are an important prerequisite if medical error is to be minimized. Even at times of low volume, however, medical error is probably common. Engineering human factors and operational procedures, promoting team coordination, and standardizing care processes can decrease error and are strongly promoted. Such efforts should be coupled to systematic analysis of errors that occur. Reliable reporting is likely only if the system is based within the specialty to help ensure proper analysis and decrease threat. Ultimate success will require dedicated effort, continued advocacy, and promotion of research.