Emergency departments need to do more to maximize patient safety
Much more can be done to improve patient safety in emergency departments (EDs), say clinicians who work there. In a recent survey, clinicians reported problems related to the ED physical environment, staffing, inpatient coordination, and information coordination and consultation.
The findings come from a survey of 3,562 health care providers who worked at 65 EDs across the country. Most of those surveyed felt the ED needed to be bigger; only 38 percent were satisfied with the current space. A third said the number of patients consistently exceeded their ED's capacity to provide safe care and 31 percent reported patients receiving care in the hallways. Only 6 percent indicated that patients admitted to the hospital from the ED were transferred in less than 1 hour. Most felt that medications, monitoring devices, and stretchers were consistently available and working properly. Half reported difficulty when it came to gaining access to a patient's medical record.
Staffing was also a problem. While 60 percent of ED clinicians felt physician staffing was sufficient, only 33 percent felt the same way about nurse staffing. Less than half of those surveyed (45 percent) did not believe clinical information was consistently transferred between physicians during shift changes. More than half (58 percent) felt the same way about nurses' transfer of information. Only 15 percent of those surveyed reported that individuals were consistently blamed when safety problems happened in the ED. Another 46 percent said this was the case some of the time. Only half felt that hospital administrators supported patient safety improvements on a consistent basis. Nevertheless, the majority of those surveyed felt that patient safety was a top priority at their ED and 70 percent indicated that efforts were underway to improve patient safety. The study was supported in part by the Agency for Healthcare Research and Quality (HS13099).
See "The safety of emergency care systems: Results of a survey of clinicians in 65 US emergency departments," by David J. Magid, M.D., M.P.H., Ashley F. Sullivan, M.S., M.P.H., Paul D. Cleary, Ph.D., M.P.H., and others, in the December 2008 online edition of the Annals of Emergency Medicine, available at http://www.ncbi.nlm.nih.gov/pubmed/19054592.
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