The Safety of Emergency Care Systems: Results of a Survey of Clinicians in 65 US Emergency Departments

Source: David J. Magid, Ashley F. Sullivan, Paul D. Cleary, Sowmya R. Rao, James A. Gordon, Rainu Kaushal, Edward Guadagnoli, Carlos A. Camargo Jr, David Blumenthal, Annals of Emergency Medicine, published online: December 2008
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From a Robert Wood Johnson Foundation summary:
A survey of hospital emergency department (ED) physicians and nurses published online in the Annals of Emergency Medicine asserts that substantial changes in the structure and management of U.S. EDs are needed to maximize patient safety and workplace satisfaction, the Wall Street Journal reports. Funded by the U.S. Department of Health and Human Services’ Agency for Healthcare Research and Quality, a team of researchers led by the Kaiser Permanente Colorado Institute for Health Research surveyed 3,562 ED clinicians in 65 hospitals to assess their perception of workplace safety and conditions. According to the data, 40 percent of respondents reported that physician staffing was insufficient to handle patient loads during busy times, while two-thirds of surveyed clinicians indicated the same for nurse staffing. Although the majority of respondents believed that physicians and nurses consistently worked well together and communicated appropriately about care plans, they suggested that efforts to improve the information exchange process during patient handoffs could improve care quality. Assessing clinician training, meanwhile, the majority of respondents reported that triage nurses were adequately trained to perform emergency assessments and that they felt comfortable questioning physicians’ orders. One-half of respondents, however, indicated that they believed nurses were not receiving adequate support from ancillary personnel. Survey respondents also indicated that frequent interruptions during patient care, difficulties in finding and accessing patients’ medical records, and clinicians’ perceptions that the ED environment does not foster a culture of safety may compromise efforts to provide safe ED care. Based on the findings, the researchers recommend an increase in staffing during periods of high demand and an increase in use of health information technology, including computer workstations and electronic medical records. In addition, the researchers recommend that EDs redesign care processes to enhance information sharing and take steps to improve patient transitions between the ED and inpatient areas

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