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Petrino R, Biondi C, Castrillo LG. Healthcare professionals' perceptions of patient safety in European emergency departments: a comparative analysis of survey results. Intern Emerg Med 2024; 19:1121-1127. [PMID: 38278968 PMCID: PMC11186879 DOI: 10.1007/s11739-023-03523-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 12/22/2023] [Indexed: 01/28/2024]
Abstract
Patient safety is a significant concern worldwide. The Emergency Departments (EDs) are vulnerable to adverse events. Europe, with its diverse healthcare systems, differs in patient safety. This study aimed to identify safety challenges through a comparative analysis of healthcare professionals' perceptions of patient safety in European EDs. In early 2023, a validated questionnaire was distributed to European ED professionals, meeting specific response rate criteria. The questionnaire included five safety domains and additional questions about infection control and team morale, with 36 ordinal scale questions. Responses ranged in five levels from "Never" to "Always," and the scores were summed to calculate the total safety score (TSS). The study examined the impact of per capita healthcare expenditure on safety perceptions using descriptive statistics, correlation assessments and SPSS 17 used for the analysis. The analysis of 1048 valid responses from 24 European countries revealed significant variability in safety perceptions. Teamwork scored highest, signifying effective collaboration. Common safety issues included overcrowding, patient flow management, understaffing, limited training and facilities for mental illnesses. TSS showed correlation with team morale and infection control, but no correlation with per capita healthcare expenditure. This comparative study underlines the disparities in patient safety perceptions across European EDs. Each country displayed unique safety concerns. Safety perceptions did not align with per capita healthcare expenditure, indicating that addressing ED safety needs multifaceted strategies. Policymakers can leverage these findings to inform strategic planning, encouraging targeted interventions to enhance patient safety at both the national and European levels.
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Affiliation(s)
- Roberta Petrino
- Emergency Medicine Unit, Department of Critical Care, Ente Ospedaliero Cantonale, Via Tesserete 46, 6900, Lugano, Switzerland.
| | - Carola Biondi
- Emergency Medicine Unit, Department of Critical Care, Ente Ospedaliero Cantonale, Via Tesserete 46, 6900, Lugano, Switzerland
| | - Luis Garcia Castrillo
- Department of Emergency Medicine, Hospital Universitario Marques de Valdecilla, Santander, Spain
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Cooper A, Edwards M, Davies F, Price D, Anderson P, Carson-Stevens A, Cooke M, Dale J, Donaldson L, Evans BA, Harrington B, Hepburn J, Hibbert P, Hughes TC, Porter A, Siriwardena AN, Watkins A, Snooks H, Edwards A. Programme theories to describe how different general practitioner service models work in different contexts in or alongside emergency departments (GP-ED): realist evaluation. Emerg Med J 2024; 41:287-295. [PMID: 38649248 PMCID: PMC11041563 DOI: 10.1136/emermed-2023-213426] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 02/15/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Addressing increasing patient demand and improving ED patient flow is a key ambition for NHS England. Delivering general practitioner (GP) services in or alongside EDs (GP-ED) was advocated in 2017 for this reason, supported by £100 million (US$130 million) of capital funding. Current evidence shows no overall improvement in addressing demand and reducing waiting times, but considerable variation in how different service models operate, subject to local context. METHODS We conducted mixed-methods analysis using inductive and deductive approaches for qualitative (observations, interviews) and quantitative data (time series analyses of attendances, reattendances, hospital admissions, length of stay) based on previous research using a purposive sample of 13 GP-ED service models (3 inside-integrated, 4 inside-parallel service, 3 outside-onsite and 3 with no GPs) in England and Wales. We used realist methodology to understand the relationship between contexts, mechanisms and outcomes to develop programme theories about how and why different GP-ED service models work. RESULTS GP-ED service models are complex, with variation in scope and scale of the service, influenced by individual, departmental and external factors. Quantitative data were of variable quality: overall, no reduction in attendances and waiting times, a mixed picture for hospital admissions and length of hospital stay. Our programme theories describe how the GP-ED service models operate: inside the ED, integrated with patient flow and general ED demand, with a wider GP role than usual primary care; outside the ED, addressing primary care demand with an experienced streaming nurse facilitating the 'right patients' are streamed to the GP; or within the ED as a parallel service with most variability in the level of integration and GP role. CONCLUSION GP-ED services are complex . Our programme theories inform recommendations on how services could be modified in particular contexts to address local demand, or whether alternative healthcare services should be considered.
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Affiliation(s)
- Alison Cooper
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Michelle Edwards
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Freya Davies
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Delyth Price
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Pippa Anderson
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Andrew Carson-Stevens
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Matthew Cooke
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Jeremy Dale
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | | | - Barbara Harrington
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Julie Hepburn
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Peter Hibbert
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | | | - Alison Porter
- Swansea University Medical School, Swansea University, Swansea, UK
| | | | - Alan Watkins
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Helen Snooks
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Adrian Edwards
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
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Kintrilis N, Blek N, Blek S, Olkiewicz A, Ladny JR, Szarpak L. Effect of the pandemic on prehospital management of patients with mental and behavioral disorders: a retrospective cohort study. Front Public Health 2023; 11:1174693. [PMID: 37780449 PMCID: PMC10535562 DOI: 10.3389/fpubh.2023.1174693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 08/24/2023] [Indexed: 10/03/2023] Open
Abstract
The novel severe acute respiratory syndrome coronavirus (SARS-CoV-2) infection and the accompanying coronavirus disease (Covid-19) have shifted the priority of human and technical resources toward their handling, thus affecting the usual standards of care for populations diagnosed with other clinical entities. The phenomenon becomes even more apparent in patients with presenting symptoms of mental and behavioral disorders, a category already vulnerable and underrepresented in regard to its prehospital approach and management. For the purposes of the current retrospective cohort study, we used records of the Polish National Emergency Medical Service Command Support System for the time period between April 1, 2019 and April 30, 2021, the official register of medical interventions delivered in Poland by Emergency Medical Services (EMS). We aimed to examine the potential impact of the COVID-19 pandemic across the Masovian Voivodeship on individuals seeking medical care for mental and behavioral disorders pertaining in the "F" category of the International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10). We examined the individuals' baseline characteristics, prehospital vital parameters and EMS processing times in a population of 59,651 adult patients (04/2019-03/2020, 28,089 patients, 04/2020-03/2021, 31,562 patients) handled by EMS teams. Compared to pre-COVID-19, EMS personnel handled fewer patients, but more patients required mental and behavioral care. Throughout the duration of the pandemic, all prehospital time periods were significantly delayed due to the increased time needed to prepare crew, vehicles, and technical equipment to ensure COVID-19 prevention and overcrowding in Emergency Departments (EDs).
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Affiliation(s)
- Nikolaos Kintrilis
- Infectious Disease Unit, General Military Hospital of Athens, Athens, Greece
| | - Natasza Blek
- Institute of Outcomes Research, Maria Sklodowska-Curie Medical Academy in Warsaw, Warsaw, Poland
- Department of Neurology, Wolski Hospital, Warsaw, Poland
| | - Sergiusz Blek
- Research Unit, Polish Society of Disaster Medicine, Warsaw, Poland
| | | | - Jerzy Robert Ladny
- Department of Emergency Medicine, Bialystok Medical University, Białystok, Poland
| | - Lukasz Szarpak
- Henry J.N. Taub Department of Emergency Medicine, Baylor College of Medicine Houston, Houston, TX, United States
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Sampson EL, Wright J, Dove J, Mukadam N. Psychiatric liaison service referral patterns during the UK COVID-19 pandemic: An observational study. THE EUROPEAN JOURNAL OF PSYCHIATRY 2022; 36:35-42. [PMID: 35068641 PMCID: PMC8762608 DOI: 10.1016/j.ejpsy.2021.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 05/28/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND OBJECTIVES COVID-19 has had a profound effect on mental health. Liaison psychiatry teams assess and treat people in mental health crises in emergency departments (EDs) and on hospital wards. During the first pandemic wave, new Mental Health Crisis Assessment Services (MHCAS) were created to divert people away from EDs. Our objective was to describe patterns in referrals to psychiatric liaison services across the North Central London care sector (NCL) and explore the impact of a new MHCAS. METHODS Retrospective study using routinely collected data (ED and ward referrals) from five liaison psychiatry services across NCL (total population 1.5 million people). We described referrals (per week and month) by individual liaison services and cross-sector, and patterns of activity (January 1st 2020 -September 31st 2020, weeks 1-39) compared with the same period in 2019. We calculated changes in the proportion of ED attendees (all-cause) referred to liaison psychiatry. RESULTS From 2019-2020, total referrals decreased by 16.5% (12,265 to 10,247), a 16.4% decrease in ED referrals (9528 to 7965) and 16.6% decrease in ward referrals (2737 to 2282). There was a marked decrease in referrals during the first pandemic wave (March/April 2020), which increased after lockdown ended. The proportion of ED attendees referred to liaison psychiatry services increased compared to 2019. CONCLUSIONS People in mental health crisis continued to seek help via ED/MHCAS and a higher proportion of people attending ED were referred to liaison psychiatry services just after the first pandemic wave. MHCAS absorbed some sector ED activity during the pandemic.
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Affiliation(s)
- E L Sampson
- Division of Psychiatry, Faculty of Brain Sciences, University College London, 149 Tottenham Court Rd, London W1T 7NF, United Kingdom
- Barnet Enfield and Haringey Mental Health Trust Liaison Psychiatry Team, North Middlesex University Hospital, Sterling Way, London, United Kingdom
| | - J Wright
- Barnet Enfield and Haringey Mental Health Trust Liaison Psychiatry Team, North Middlesex University Hospital, Sterling Way, London, United Kingdom
| | - J Dove
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, 4 St Pancras Way, London NW1 0PE, United Kingdom
| | - N Mukadam
- Division of Psychiatry, Faculty of Brain Sciences, University College London, 149 Tottenham Court Rd, London W1T 7NF, United Kingdom
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, 4 St Pancras Way, London NW1 0PE, United Kingdom
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Cooper A, Carson-Stevens A, Edwards M, Davies F, Donaldson LJ, Anderson P, Cooke M, Dale J, Evans BA, Harrington B, Hepburn J, Hibbert P, Hughes T, Porter A, Siriwardena AN, Snooks H, Edwards A. Identifying safe care processes when GPs work in or alongside emergency departments: a realist evaluation. Br J Gen Pract 2021; 71:e931-e940. [PMID: 34048363 PMCID: PMC8544118 DOI: 10.3399/bjgp.2021.0090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/17/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Increasing pressure on emergency services has led to the development of different models of care delivery including GPs working in or alongside emergency departments (EDs), but with a lack of evidence for patient safety outcomes. AIM This study aimed to explore how care processes work and how patient safety incidents associated with GPs working in ED settings may be mitigated. DESIGN AND SETTING Realist methodology with a purposive sample of 13 EDs in England and Wales with different GP service models. The study sought to understand the relationship between contexts, mechanisms, and outcomes to develop theories about how and why patient safety incidents may occur, and how safe care was perceived to be delivered. METHOD Qualitative data were collected (observations, semi-structured audio-recorded staff interviews, and local patient safety incident reports). Data were coded using 'if, then, because' statements to refine initial theories developed from an earlier rapid realist literature review and analysis of a sample of national patient safety incident reports. RESULTS The authors developed a programme theory to describe how safe patient care was perceived to be delivered in these service models, including: an experienced streaming nurse using local guidance and early warning scores; support for GPs' clinical decision making, with clear governance processes relevant to the intended role (traditional GP approach or emergency medicine approach); and strong clinical leadership to promote teamwork and improve communication between services. CONCLUSION The findings of this study can be used as a focus for more in-depth human factors investigations to optimise work conditions in this complex care delivery setting.
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Affiliation(s)
- Alison Cooper
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Andrew Carson-Stevens
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Michelle Edwards
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Freya Davies
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | | | | | - Matthew Cooke
- Division of Health Sciences, Warwick Medical School, Coventry, UK
| | - Jeremy Dale
- Division of Health Sciences, Warwick Medical School, Coventry, UK
| | | | | | | | - Peter Hibbert
- Australian Institute of Health Innovation, Macquarie University, Australia
| | | | - Alison Porter
- Institute of Life Science 2, Swansea University Medical School, Swansea, UK
| | | | - Helen Snooks
- Institute of Life Science 2, Swansea University Medical School, Swansea, UK
| | - Adrian Edwards
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
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Affiliation(s)
- Molly McCarthy
- School of Psychology, Liverpool John Moores University, Liverpool, UK
- Cheshire and Wirral Partnership NHS Foundation Trust
| | - Pooja Saini
- School of Psychology, Liverpool John Moores University, Liverpool, UK
- Cheshire and Wirral Partnership NHS Foundation Trust
| | - Rajan Nathan
- School of Psychology, Liverpool John Moores University, Liverpool, UK
- Cheshire and Wirral Partnership NHS Foundation Trust
| | - Jason McIntyre
- School of Psychology, Liverpool John Moores University, Liverpool, UK
- Cheshire and Wirral Partnership NHS Foundation Trust
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McLoughlin C, McLoughlin A, Jain S, Abdalla A, Cooney J, MacHale S. The suburban-city divide: an evaluation of emergency department mental health presentations across two centres. Ir J Med Sci 2021; 190:1523-1528. [PMID: 33392979 DOI: 10.1007/s11845-020-02496-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 12/19/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the characteristics of mental health presentations to the emergency department in two different hospital settings. METHODS This was a retrospective cross-sectional study examining ED referrals to psychiatry in an inner-city and suburban centre. The authors collected data on gender, age, employment, housing, clinical presentation, time of assessment and admissions, over a 1-month period. RESULTS The total number referred was 213: inner-city n = 109 and suburban n = 104. The inner-city saw a younger population; 47/109 (43%) were aged between 20 and 29 years, compared with 28/104 (27%) of suburban presenters (P value 0.0134). A higher number of presenters were aged over 60 in the suburban centre n = 13/104 (12.5%) versus the inner-city centre 3/109 (2.8%) (P value 0.0084). In the inner-city, the proportion of homeless presenters was significantly higher at 30/109 (28%) versus 5/104 (4.8%) in the suburban setting (P < 0.0001). Presentations related to substances were highest, a total of 73 (34.3%) across both centres, with no significant difference in clinical presentations across the two centres. The majority were seen in the on-call period, 74/109 (67.9%) in the inner-city centre and 66/104 (63.5%) in the suburban centre. The psychiatric admission rate was significantly different between the two centres, with 33/109 (30.3%) patients admitted in the inner-city centre and 13/104 (12.5%) patients admitted in the suburban centre (P value 0.002). CONCLUSIONS A large proportion of ED referrals to psychiatry constitute patients with unmet social and addiction needs, who are seen out of hours. This prompts consideration of expanding both ED and community services to comprise a more multidisciplinary-resourced, 24/7 care model.
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Affiliation(s)
| | | | | | - Ahad Abdalla
- Limerick University Hospital Group, Limerick, Ireland
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