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206 The Journal of Emergency Medicine

rrors in the ED. We hypothesize that medication errors associatedith temporary staff are more likely to lead to greater harm thanedication errors not associated with temporary staff. Methods: A

ross-sectional study of all ED errors reported to the MEDMARXystem, an Internet-based medication error reporting program de-igned to allow hospitals to report and track error data, between000 and 2005. Results: For the years 2000 to 2005, a totalf 23,863 medication error reports occurred in the ED from92 hospitals; 244 have a contributing factor of “staff,gency/temporary” and the remaining 23,619 served as theomparison group. Errors caused by temporary staff resultedn significantly more harm than those caused by regular staffp � 0.04). Conclusion: Medication errors in the ED asso-iated with temporary staff are more harmful than thosessociated with regular staff. We recommend that institu-ions re-evaluate their temporary staff policies and consideratient care risks as well as benefits in the use of temporarytaff when establishing staffing mix patterns in the ED.

Financial sponsor: Johns Hopkins Medicine. The authorsave no financial interests to disclose.

944 (#9) King

CHART REVIEW AND POTENTIAL PREVENT-BLE ERROR DETECTION IN THE EMERGENCY DE-ARTMENT. Reginald King, MBBS, MSC, DM, Queen Elizabethospital, Christ Church, BARBADOS.

Study Objective: To determine the utility of chart reviews a method of error detection and to identify its role in auditnd continuous quality improvement in the Emergency De-artment (ED). Methods: There were 495 notes chosen atandom over a 3-month period and reviewed using an im-licit method. The audit was performed using an instrumentesigned and tested in the ED of the Queen Elizabeth hos-ital, Barbados. The results of the audit were analyzed usinghi-squared tests to determine patient and physician factorsssociated with errors (confidence interval 95%, p value �.05 was considered significant). Results: The auditor deter-ined that there was a high risk of unsatisfactory outcome in

0.8% of patients seen in the ED. Implicit audit was foundo have wide variation in levels of detection, dependent uponhe opinion of the auditor. Errors were significantly moreikely to occur in patients at the extremes of age and in thoseresenting with traumatic complaints. Patient gender wasot a significant factor in the occurrence of errors. Notes ofatients seen by less experienced physicians were not moreikely to contain errors. Failures to consider and rule outmportant differential diagnoses were the most commonauses of errors. Errors were also likely due to inadequatelyocumented discharge plans and discharge instructions. Theudit of an individual note was noted to take � 5 min.onclusion: Chart review and implicit audit, although not an

deal method of error detection, has a role in the ED. It maye implemented cheaply and with limited impact on staffingnd manpower. The benefits of such a program include therovision of a safety net for patients seen in the department,

tool for building evidence-based guidelines for care of the b

opulation studied, and a tool for guiding educational pro-rams and other continuous quality improvement methods.

Keywords: Accident and Emergency Department; audit;hart review; error; adverse events; preventable error; po-ential preventable error; patient safety; continuous qualitymprovement.

962 (#13) C. Williams

FREQUENT ATTENDEES TO THE EMERGENCYEPARTMENT. Chaynie Williams, MBBS, DM, Queen Eliza-eth Hospital, St. Michael, BARBADOS.

Objective: To determine the prevalence of frequent attendeeso the emergency department (ED) and highlight their contributiono the overall visits. To describe, also, the nature of the patients’isits in terms of their demographical, clinical, and utilizationharacteristics. Methods: A retrospective cross-sectional surveyas conducted on all patients presenting to the ED at the Queenlizabeth Hospital in Barbados over a 12-month period. Patientsere then divided into groups and compared for attendance trends.

Frequent attendees” are patients who visited the department fiver more times in 1 year. Results: Frequent attendees represent.2% of the patient population and account for 15.8% of all visits.isits ranged from 1–59 per patient during the year 2001. Thereere 6682 visits made by these patients. There was a slight maleredominance; the “age of majority” was actually those aged � 21ears. Most patients visited with complaints due to asthma21.4%), non-extremity trauma, musculoskeletal disorders, andastrointestinal disorders, in descending order. Patients preferredo present between 8:00 a.m. and 8:00 p.m. and on Sundays and

ondays. Frequent attendees were more likely to arrive via am-ulance and have a higher triage code, but less likely to bedmitted. Discussion: Asthma is a dominant chronic conditionmong frequent ED users. Traumatic conditions are also of con-ern in patients who have high return rates. Recommendations forcurriculum should include chronic management training as well

s teaching skills to impart continuous medical education onrevention of injuries to the public. In addition, a multidisciplinarypproach to patients at risk for multiple return visits is essential,ot primarily to reduce visits but to better meet patient needs.

966 (#14) Hayden

ACCURACY OF A SET OF CLINICAL CRITERIAOR THE DIAGNOSIS OF ARTERIAL GAS EMBO-ISM. Stephen R. Hayden, MD, University of California, Saniego Medical Center, San Diego, California.

Introduction: Arterial gas embolism (AGE) is a leadingause of morbidity and mortality in scuba diving. The diagnosiss made based on exposure to barotrauma or air entry into theirculation and a variety of clinical parameters. To date, theres not a well-defined set of criteria that reliably predicts AGE.he objective of this study was to test the accuracy of aroposed set of diagnostic criteria from the San Diego Hyper-aric Oxygen Group (SANDHOG) for the diagnosis of AGE.hese simple criteria have the potential to be applied by emer-ency physicians to aid in determining whether further hyper-

aric consultation or treatment is necessary. Materials and