WASHINGTON, D.C.--The American College of Emergency Physicians (ACEP) along with eight other medical organizations representing the specialty of emergency medicine in the United States have sent a letter to the leadership at the Agency for Healthcare Research and Quality (AHRQ) expressing our concerns about the systematic review by Dr. David Newman-Toker, et. al., entitled Diagnostic Errors in the Emergency Department: A Systematic Review.

This work was conducted through an Evidence-Based Practice Center as part of AHRQ’s Effective Health Care Program. After reviewing the executive summary and initial draft, we believe that the report makes misleading, incomplete, and erroneous conclusions from the literature reviewed and conveys a tone that inaccurately characterizes and unnecessarily disparages the practice of emergency medicine in the US.

The field of emergency medicine is continually evolving, in terms of the available diagnostic and clinical tools, practice standards, the staffing and physical environment of the EDs, and the training standards of emergency physicians worldwide. While most medical specialties have similar training in all Western or advanced nations, emergency medicine does not. In fact, neither of the countries analyzed, Spain and Switzerland, had emergency medicine residency training at the time of the research period. Whereas emergency medicine has existed in the U.S. for decades. Given the complex nature of emergency care, it stands to reason that the lack of proper training could lead to higher diagnostic miss rate.

As with all medical specialties, there is room for improvement in the diagnostic accuracy of emergency care. All of us who practice emergency medicine are committed to improving care and reducing diagnostic error, and we appreciate the commitment and attention AHRQ has given to health and safety. As we’ve learned from the COVID pandemic, there is no replacement for access to high-quality emergency care and greater harm can result when patients are afraid to come to the emergency department and delay their critical diagnoses. It is with patients in mind that we submitted our concerns regarding this report.