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More reasons why not to visit an emergency room when you don’t need to. From a Medscape conference report on emergency medicine.

As in all organizations, there are system errors and intrinsic errors in the ED (Emergency Department). System errors pertain to design, both physical and process design. The physical design of the ED, because of the varying patient loads, is necessarily imperfect. Design of specific equipment may not match every need at every moment. Adequate lines of vital supplies depend on managers with whom individual physicians may or may not have any direct contact. Further, all of these factors may occur in the context of ED overcrowding and boarding, unpredictable patient surges, high noise levels (acoustic and otherwise), and inadequate staffing. These issues, only some of which are even minimally correctable, are inherent to the practice of emergency medicine, and many errors can be traced back to the working conditions and environment in the ED. For those issues that can be addressed, protocols and proactive management can help move toward their resolution.

Within the disorder of a busy ED, and the potential for system errors, physicians must also deal with the potential for intrinsic errors. These sources of error include:

· High levels of diagnostic uncertainty;

· “Decision density,” or the volume of decisions that are made in a given amount of time;

· A high amount of cognitive load needed to process a large volume of data;

· Narrow time windows for patient assessment;

· Multiple care transitions for any given patient; and

· A multitude of interruptions and distractions throughout the thought process.

This list is compounded by “surge phenomena” (unpredictable sharp increases in patient volume), physician fatigue, and sleep cycle disturbances as well as novel and unpredictable conditions, such as unplanned illnesses or absences that reduce staffing or hospital disasters, including chemical exposures or unforeseen contaminations within the hospital.