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“Is it safe to put this tube into this patient's chest?” “Is this medication OK at this dose, for this patient's renal function, in the context of the other medications she is taking?” “Can I safely send this patient home?” “Am I comfortable with the follow-up I have arranged?” These are among the central questions that lay the framework for Patient Safety in Emergency Medicine.

The format of the book is an eclectic composite of chapters loosely organized under diverse subject headings such as Organizational Approaches to Safety, Designing and Managing the Safe Emergency Department, Safe Medical Practice, and The Aftermath of Medical Failure. Chapter authors possess diverse backgrounds and include experts in psychology, sociology, management, and public health. This diversity allows readers to view common clinical practices in a different light. For instance, even the experienced clinician may come away with a different understanding of the ramifications of apologizing for a medical error when explained by an author with expertise in claims analysis and risk management.

Between the obligatory introduction and conclusion each chapter departs from any recognizable conformity and authors appear limited only by the amount of ink in their pens and the 4 corners of the page. While some chapter authors follow their introductions with a section dedicated to etiology (Approaches to Understanding Success and Failure) or terminology (Shiftwork, Fatigue, and Safety in Emergency Medicine) others delve right into the subject at hand (Individual Factors in Patient Safety). Readers who like to cling to a common thread running between chapters may be left dangling by this approach. In short, the book walks a tightrope strung between structural license and organizational chaos. Also, consistent use of quick-reference tables or comprehensive lists is lacking which places the book closer to a coffee table near a comfy chair and warm milk than on the shelf of a busy emergency department (ED).

However, no matter where the book is read, it can be said the authors accomplish their primary intent: to identify problem areas within the practice of emergency medicine that challenge safe health care delivery and to propose solutions to these problems. For instance, the chapter on Medical Informatics and Patient Safety alerts the reader to safety pitfalls in prescription writing and demonstrates how decision support systems can mitigate associated risks by decreasing potential adverse drug events, checking allergies, and identifying drug-drug interactions. Similarly, Communication in Emergency Medical Teams walks the reader through typical ED communication systems pointing out interruptions to successful transfer of information along the way. Identifying individual characteristics that might influence clinical performance and impact patient safety is discussed in Individual Factors in Patient Safety.

Comparative shopping will be made easy with the recognition that Patient Safety in Emergency Medicine is the first comprehensive treatise on this topic. Extant emergency texts treat safety as a secondary or tertiary issue and fail to mention many of the issues covered by the authors such as the use of algorithms, clinician fatigue and laboratory error.

Overall, the authors accomplished what they set out to do. They make readers aware of at-risk areas of patient safety while proposing ways to decrease those risks. They do this in a depth that ranges from the inception of an emergency department to what steps to follow in the aftermath of a medical failure. Furthermore, they have the chutzpah to cover such topics as error disclosure and crowding. Because of this depth, I anticipate the target readership to be vast-ranging from ED managers and administrators to graduating emergency medicine residents starting their careers as attending physicians. This is a worthwhile read and I congratulate the authors on a job well done.