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Joint Letter on AHRQ Report

As experts in emergency medicine, our organizations are committed to improving patient care in the practice of emergency medicine. Yet, we are deeply concerned about the recently released report and systematic review by Dr. David Newman-Toker, et. al., entitled Diagnostic Errors in the Emergency Department: A Systematic Review. 1 This work was conducted through an Evidence-Based Practice Center (EPC) 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 (EM) in the United States (U.S.).

Some of these concerns were shared directly with AHRQ staff during a November 21, 2022, phone call requested by the American College of Emergency Physicians (ACEP). At that time, it was requested that dissemination of the report be delayed and that EM organizations be provided an opportunity to work with the authors to re-examine the conclusions in light of the unique practice of emergency medicine and present the findings more productively. We recognize and respect that AHRQ and the EPC followed their standard procedure, which included an opportunity for public comment. However, we also are deeply concerned that publishing this faulty document would have negative implications for both our current workforce and our future pipeline of emergency physicians, as well as the millions of people who seek emergency care in the U.S.

We understand and agree that there is room for improvement in the diagnostic accuracy in emergency care - just as there is in all specialties. All of us who practice EM are committed to improving care and reducing diagnostic error. However, we also believe the potential unintended consequences of the report, as drafted, inappropriately take aim at a standard of care designed to stabilize and treat the undifferentiated patient in times of an acute emergency.

Our concerns with the draft report fall into the following four key areas.

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