Physicians’ and nurses’ perceptions of patient safety risks in the emergency department

Källberg, Ann-Sofie; Ehrenberg, Anna; Florin, Jan; Östergren, Jan; Göransson, Katarina E.

doi:10.1016/j.ienj.2017.01.002

Cited by 54 publications

(63 citation statements)

References 39 publications

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“…Research has highlighted the importance of staff being fully aware of and having a shared understanding of the purpose of checklists (Clay-Williams & Colligan, 2015;Hales et al, 2008;Kallberg et al, 2017). Initiatives such as "intentional rounding," which bears many similarities with the ED Safety Checklist, are based on clinical staff delivering care within specified time frames in a proactive manner.…”

Section: Discussionmentioning

confidence: 99%

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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Section: Discussionmentioning

confidence: 99%

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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“…In our study, about one-third of the patients used NSAIDs although they had not been evaluated for renal function, and NSAIDs were used in visits with severe liver disease. A lot of patients who needed health services went to EDs; this high work load caused problems for clinicians in EDs [36]. A lack of evaluation about necessary investigations might be a result of this situation.…”

Section: Discussionmentioning

confidence: 99%

Quality of gout care in the emergency departments: a multicentre study

et al. 2020

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Background: To report on prevalence of gout flare in emergency departments and to report the quality of gout care in emergency departments and causes of admission at emergency departments. Methods: A retrospective chart review of visits that had a primary diagnosis in gout by the International Classification of Diseases, the tenth revision, at emergency departments from 6 universities in Thailand over a 5 year period from 1 January 2012 to 31 December 2016. Results: Six hundred thirty-two visits were included to the study. Prevalence of gout flare in emergency departments was 0.04. Only 29.3% of the visits had arthrocentesis. 628/632 (99.4%) and 519/585 (88.7%) of the visits were prescribed medications in emergency departments and had home medications, respectively. Although all visits that were prescribed colchicine in emergency departments received adequate doses of colchicine, it was also found that more than 2.4 mg/day of colchicine was prescribed (3/394, 0.8%) for home medications. In addition, 183/343 (53.4%) of the visits with normal renal function were prescribed non-steroidal anti-inflammatory drugs (NSAIDs). However, prescribed NSAIDs in abnormal renal function (42/343, 12.2%) was also found. The interruption of dosing, including increase, decrease, addition or discontinuance of urate lowing therapy in a gout flare period was 42/632 (6.6%). The most common cause of admission was acute gouty arthritis (31/47, 66.0%). Conclusions: Quality of gout care in the emergency departments was not good. Inappropriate management of gout flare in emergency departments was demonstrated in our study, particularly with regard to investigations and pharmacological management. Gaps between clinicians and guidelines, the knowledge of clinicians, and overcrowding in emergency departments were hypothesized in the results.

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“…In high-risk patient areas such as the waiting room, effective communication is fundamental to the provision of safe, quality care [31], while failed communication leads to poor ED patient outcomes [32]. A crucial aspect of effective communication is therapeutic nurse-patient relationships.…”

Section: Discussionmentioning

confidence: 99%

A profile of the waiting room nurse in emergency departments: An online survey of Australian nurses exploring implementation and perceptions

Innes

Jackson

Plummer

et al. 2019

International Emergency Nursing

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Background In response to increasing waiting times, adverse patient outcomes and patient dissatisfaction, some emergency departments introduced a Waiting Room Nurse role. Despite implementation into routine practice, there remains limited formal evaluation of the role. Aim To explore the implementation of a Waiting Room Nurse role in Australian emergency departments and emergency nurses' perceptions. Methods Survey design. A 40-item survey was developed, piloted and then distributed to members of a professional College for online completion. Responses for closed-ended and openended items were reported using frequencies or proportions, and quantitative content analysis, respectively. Results Respondents (n=197) reported that 51 emergency departments allocated a Waiting Room Nurse, with varying hours of operation. Five key areas of responsibility were: patient care, patient safety, escalation of care, triage and communication. Role variations were identified in experience, preparation and supporting policies. Challenges, including workload and personal safety issues, were reported. Conclusions The role was perceived as vital, especially at times of high demand, in ensuring that patients were safe to wait, detecting deterioration and escalating care as needed. 2 Communication and therapeutic relationships were key to effective performance. Challenges identified had clear implications for the welfare of nurses performing the role.

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Physicians’ and nurses’ perceptions of patient safety risks in the emergency department

Cited by 54 publications

References 39 publications

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

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

Quality of gout care in the emergency departments: a multicentre study

A profile of the waiting room nurse in emergency departments: An online survey of Australian nurses exploring implementation and perceptions

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