Emergency department checklist: an innovation to improve safety in emergency care

Redfern, Emma; Hoskins, Rebecca; Gray, J.D.; Lugg, Jason; Hastie, Alex; Clark, Caroline; Benger, Jonathan

doi:10.1136/bmjoq-2018-000325

Cited by 5 publications

(7 citation statements)

References 9 publications

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“…The implementation of checklist had significantly improved clinical quality, patient safety and reduced treatment delays. [9] Testing small cjange ideas by using PDSA cycles, the time gap reduced significatanly from 46.5 min to 15 minutes and sustained at 18 min till next 6weeks observations…”

Section: Discussionmentioning

confidence: 99%

Impact of targeted bundles to reduce the nebulization time gap from prescription to administration among red triaged patients in emergency department: An quality improvement initiative

Sachdeva

Kumar

Aggarwal

2021

Preprint

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BackgroundSevere exacerbation of asthma are potentially life-threatening and therefore require prompt care and frequent management. Important elements of early treatment includes recognition of early signs and symptoms of breathing difficulty and timely prescription and administration of therapeutic agents. A subsequent delay in receiving nebulization during an acute exacerbation of asthma can leads to cardiac arrest and even death. AimTo reduce the gap in administration of nebulization from its prescription time among red triaged patients by 50% from its baseline. Setting and designThis interventional study was conducted among red triaged patients in emergency department of tertiary care hospital, India . Material and MethodsBaseline information was collected during first 4 weeks to find gap in administration of nebulization from its prescription time. Fish bone analysis and process map were laid down to analyse the situation. The intervention using targeted bundles was done via 3 PDSA (PDSA1: indenting the nebulizers, PDSA 2: training of doctors and nurses, PDSA 3; introducing equipment checklist) to reduce the gap . A run chart using time series analysis model was used to compare the pre and post intervention nebulization gap. ResultsTotal 74 patients (30 in pre- intervention, 44 in post intervention) admitted in red triaged area were observed for nebulization gap from prescription to administration. Median time for nebulization gap before intervention was 46.5 minutes which reduced to 15 minutes in post intervention phase. ConclusionThis bundles of targeted interventions was successful to reduce the nebulization gap. Key words: nebulization gap, prescription time, administration time

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Section: Discussionmentioning

confidence: 99%

Impact of targeted bundles to reduce the nebulization time gap from prescription to administration among red triaged patients in emergency department: An quality improvement initiative

Sachdeva

Kumar

Aggarwal

2021

Preprint

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“…Our study provides insight into the early implementation of a patient safety checklist that has been designed in response to a profound shift in the demand on EDs in the UK (Redfern et al, 2018) especially in the winter periods where crowding undermines patient safety (Maguire et al, 2016). There is currently no published research-based evidence that the ED Safety Checklist improves patient safety, but it is premised on the basis of a substantial body of evidence which demonstrates the value of checklists in health care and in industries where safety is paramount (Catchpole, 2015;Hales, Terblanche, Fowler, & Sibbald, 2008;Kapur, Parand, Soukup, Reader, & Sevdalis, 2016;Kohn, Corrigan, & Donaldson, 2000).…”

Section: Discussionmentioning

confidence: 99%

“…The ED Safety Checklist was developed initially as a quality improvement project (Redfern et al, 2018) and subsequently rolled out across six hospitals in the West of England. Small local adaptations were made at each hospital to reflect particular ED workflows and Relevance to clinical practice: The Emergency Department Safety Checklist is a response to an overcrowded environment.…”

Section: Backg Rou N Dmentioning

confidence: 99%

“…The ED Safety Checklist was developed initially as a quality improvement project (Redfern et al, 2018)…”

Section: Backg Rou N Dmentioning

confidence: 99%

“…To address these patient safety issues, an ED safety checklist (see Appendix S2) was developed by University Hospitals Bristol NHS Foundation Trust in 2014(The Kings Fund, 2018Redfern et al, 2018). In association with the West of England Academic Health Science Network (WEAHSN), the checklist was adopted by six hospitals in the region and has subsequently been recommended for use across NHS EDs in England (NHS Improvement, 2018).…”

Section: Introductionmentioning

confidence: 99%

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The introduction of a safety checklist in two UK hospital emergency departments: A qualitative study of implementation and staff use

Stone

Banks

Brant

et al. 2020

Journal of Clinical Nursing

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Aims and objectives To explore the extent to which a checklist designed to support patient safety in hospital Emergency Departments was recognised and used by staff. Background Patient crowding in UK Emergency Departments makes it difficult for staff to monitor all patients for signs of clinical deterioration. An Emergency Department Safety Checklist was developed at a UK hospital to ensure patients are regularly monitored. It was subsequently implemented in six hospitals and recommended for use across the National Health Service in England. Methods This was a qualitative study in two UK hospital Emergency Departments. Data collection consisted of sixty‐six hours of nonparticipant observation and interviews with twenty‐six staff. Observations were sampled across different days and times. Interviews sampled a range of staff. Data were analysed thematically. The study was undertaken in accordance with COREQ guidelines. Results Staff described the Emergency Department Safety Checklist as a useful prompt and reminder for monitoring patients' vital signs and other aspects of care. It was also reported as effective in communicating patient care status to other staff. However, completing the checklist was also described as a task which could be overlooked during busy periods. During implementation, the checklist was promoted to staff in ways that obscured its core function of maintaining patient safety. Conclusions The Emergency Department Safety Checklist can support staff in maintaining patient safety. However, it was not fully recognised by staff as a core component of everyday clinical practice. Relevance to clinical practice The Emergency Department Safety Checklist is a response to an overcrowded environment. To realise the potential of the checklist, emergency departments should take the following steps during implementation: (a) focus on the core function of clinical safety, (b) fully integrate the checklist into the existing workflow and (c) employ a departmental team‐based approach to implementation and training.

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Development of an Emergency Department Safety Checklist through a global consensus process

Rovati,

Privitera,

Finch

et al. 2024

Intern Emerg Med

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Emergency departments (EDs) are at high risk for medical errors. Checklist implementation programs have been associated with improved patient outcomes in other high-risk clinical settings and when used to address specific aspects of ED care. The aim of this study was to develop an ED Safety Checklist with broad applicability across different international ED settings. A three-round modified Delphi consensus process was conducted with a multidisciplinary and multinational panel of experts in emergency medicine and patient safety. Initial checklist items were identified through a systematic review of the literature. Each item was evaluated for inclusion in the final checklist during two rounds of web-based surveys and an online consensus meeting. Agreement for inclusion was defined a priori with a threshold of 80% combined agreement. Eighty panel members from 34 countries across all seven world regions participated in the study, with comparable representation from low- and middle-income and high-income countries. The final checklist contains 86 items divided into: (1) a general ED Safety Checklist focused on diagnostic evaluation, patient reassessment, and disposition and (2) five domain-specific ED Safety Checklists focused on handoff, invasive procedures, triage, treatment prescription, and treatment administration. The checklist includes key clinical tasks to prevent medical errors, as well as items to improve communication among ED team members and with patients and their families. This novel ED Safety Checklist defines the essential elements of high-quality ED care and has the potential to ensure their consistent implementation worldwide.

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Emergency department checklist: an innovation to improve safety in emergency care

Cited by 5 publications

References 9 publications

Impact of targeted bundles to reduce the nebulization time gap from prescription to administration among red triaged patients in emergency department: An quality improvement initiative

Impact of targeted bundles to reduce the nebulization time gap from prescription to administration among red triaged patients in emergency department: An quality improvement initiative

The introduction of a safety checklist in two UK hospital emergency departments: A qualitative study of implementation and staff use

Development of an Emergency Department Safety Checklist through a global consensus process

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