Introduction to the <i>AEM</i> special issue on the science of errors in emergency care, 2025

This commentary serves as a brief introduction and explanation to this special issue on errors. In the call for papers, we noted that this special issue would publish original reports that focus on all aspects of errors relevant to emergency care, ranging from the definition of errors, cognitive processing, diagnostic hypothesis generation, treatment, and also communication with patients and other providers. After the 2015 National Academies report1 Improving Diagnosis in Healthcare, national consciousness of diagnostic error was raised. Many scholars acknowledge that error is universal and that virtually all medical specialties contribute to harm from missed, incorrect, or delayed diagnoses. The practice of emergency medicine is particularly vulnerable with seemingly unlimited demand and finite resources, operating in acute, time-pressured situations often in the face of uncertainty. We can identify and address many of these challenges, given sufficient attention and focused effort, and this issue identifies many of the problems and potential solutions. Indeed, discussions about diagnostic error create opportunities to address many of the systemic challenges we face, including harm from ED boarding. This work fits within an ongoing discussion within emergency medicine that has had increased in prominence in recent years. This special issue in AEM was sponsored by a contract with the Agency for Healthcare Research and Quality (AHRQ) as part of their work to improve quality and safety and find strategies to address challenges faced in emergency medicine. AEM vetted over 75 submissions to arrive at a final lineup of 10 original reports, three special contributions, one systematic review, two research letters, four commentaries, and one reflection. A major point that we sought to convey was that the concept of errors is not a black-and-white, right-or-wrong science but instead is permeated with nuance in the face of uncertainty and often lacking consensus in definition and meaning. It is generally acknowledged that errors are common but infrequently lead to harm and that harm is often not due to errors. The ideal focus for improvement activities is on preventable harm and on near misses that have the potential for harm rather than errors per se. While there has been a historical focus on error, errors tend to focus on blame that inevitably falls on individuals, when many of the problems—and solutions—require a broader view of health care infrastructure and system design. A proactive focus on system design can create an environment and circumstances that can support frontline staff to deliver the care we all desire. The original articles are organized according to themes that included the role of cognitive processing (in doctors and nurses), flawed communication (including group-based inequities), potential errors of omission (treating and testing after sexual assault and notification about lung nodules and hepatic steatosis), specific conditions (e.g., pulmonary embolism in pregnancy), and a special contribution on the potential role of artificial intelligence to reduce error. We would like to think that this collection of science and opinions will help move the specialty of emergency care forward in a positive manner. The authors disclose funding from the Agency for Healthcare Research and Quality (Contract 75Q80124P0010). The authors declare no conflicts of interest.