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Petrino R, Tuunainen E, Bruzzone G, Garcia-Castrillo L. Patient safety in emergency departments: a problem for health care systems? An international survey. Eur J Emerg Med 2023; 30:280-286. [PMID: 37226830 DOI: 10.1097/mej.0000000000001044] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND AND IMPORTANCE Patient safety in healthcare is one of the cornerstones of quality of care. The emergency department (ED) is by its very nature a place where errors and safety issues are liable to occur. OBJECTIVE The aim of the study was to assess health professionals' perception of the level of safety in EDs and to identify in which work domains safety appears most at risk. DESIGN AND PARTICIPANTS Between 30 January and 27 February 2023, a survey addressing the main domains of safety was distributed to ED health care professionals through the European Society of Emergency Medicine contact network. It addressed five main domains: teamwork, safety leadership, physical environment and equipment, staff/external teams, and organisational factors and informatics, with a number of items for each domain. Further questions about infection control and team morale were added. The Cronbach's alpha measure was calculated to assure internal consistency. MEASURES AND ANALYSIS A score was developed for each domain by adding the question's value using the following ranking: never (1), rarely (2), sometimes (3), usually (4), and always (5) and was aggregated in three categories. The calculated sample size needed was 1000 respondents. The Wald method was used for analysis of the questions' consistency and X2 for the inferential analysis. MAIN RESULTS The survey included 1256 responses from 101 different countries; 70% of respondents were from Europe. The survey was completed by 1045 (84%) doctors and 199 (16%) nurses. It was noted that 568 professionals (45.2%) had less than 10 years' experience. Among respondents, 80.61% [95% confidence interval (CI) 78.42-82.8] reported that monitoring devices were available, and 74.7% (95% CI 72.28-77.11) reported that protocols for high-risk medication and for triage (66.19%) were available in their ED. The area of greatest concern was the disproportionate imbalance between needs and the availability of staff at times of greatest flow, considered sufficient by only 22.4% (95% CI 20.07-24.69) of doctors and 20.7% (95% CI 18.41-22.9) of nurses. Other critical issues were overcrowding due to boarding and a perceived lack of support from hospital management. Despite these difficult working conditions, 83% of the professionals said they were proud to work in the ED (95% CI 81.81-85.89). CONCLUSION This survey highlighted that most health professionals identify the ED as an environment with specific safety issues. The main factors appeared to be a shortage of personnel during busy periods, overcrowding due to boarding, and a perceived lack of support from hospital management.
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Affiliation(s)
- Roberta Petrino
- Department of Critical Care, Emergency Medicine Unit, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | | | - Giulia Bruzzone
- Department of Critical Care, Emergency Medicine Unit, Ente Ospedaliero Cantonale, Lugano, Switzerland
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Hayden EM, Davis C, Clark S, Joshi AU, Krupinski EA, Naik N, Ward MJ, Zachrison KS, Olsen E, Chang BP, Burner E, Yadav K, Greenwald PW, Chandra S. Telehealth in emergency medicine: A consensus conference to map the intersection of telehealth and emergency medicine. Acad Emerg Med 2021; 28:1452-1474. [PMID: 34245649 PMCID: PMC11150898 DOI: 10.1111/acem.14330] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 06/18/2021] [Accepted: 06/23/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Telehealth has the potential to significantly change the specialty of emergency medicine (EM) and has rapidly expanded in EM during the COVID pandemic; however, it is unclear how EM should intersect with telehealth. The field lacks a unified research agenda with priorities for scientific questions on telehealth in EM. METHODS Through the 2020 Society for Academic Emergency Medicine's annual consensus conference, experts in EM and telehealth created a research agenda for the topic. The multiyear process used a modified Delphi technique to develop research questions related to telehealth in EM. Research questions were excluded from the final research agenda if they did not meet a threshold of at least 80% of votes indicating "important" or "very important." RESULTS Round 1 of voting included 94 research questions, expanded to 103 questions in round 2 and refined to 36 questions for the final vote. Consensus occurred with a final set of 24 important research questions spanning five breakout group topics. Each breakout group domain was represented in the final set of questions. Examples of the questions include: "Among underserved populations, what are mechanisms by which disparities in emergency care delivery may be exacerbated or ameliorated by telehealth" (health care access) and "In what situations should the quality and safety of telehealth be compared to in-person care and in what situations should it be compared to no care" (quality and safety). CONCLUSION The primary finding from the process was the breadth of gaps in the evidence for telehealth in EM and telehealth in general. Our consensus process identified priority research questions for the use of and evaluation of telehealth in EM to fill the current knowledge gaps. Support should be provided to answer the research questions to guide the evidenced-based development of telehealth in EM.
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Affiliation(s)
- Emily M Hayden
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Christopher Davis
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Sunday Clark
- Department of Emergency Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Aditi U Joshi
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Neel Naik
- Department of Emergency Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Michael J Ward
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kori S Zachrison
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Erica Olsen
- Department of Emergency Medicine, Columbia University, College of Physicians and Surgeons, New York, NY, USA
| | - Bernard P Chang
- Department of Emergency Medicine, Columbia University, College of Physicians and Surgeons, New York, NY, USA
| | - Elizabeth Burner
- Department of Emergency Medicine, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Kabir Yadav
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Peter W Greenwald
- Department of Emergency Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Shruti Chandra
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA, USA
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Comparing the Outcomes of Reporting and Trigger Tool Methods to Capture Adverse Events in the Emergency Department. J Patient Saf 2020; 15:61-68. [PMID: 28098586 PMCID: PMC6407819 DOI: 10.1097/pts.0000000000000341] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Background Little is known about which methods are best for detecting adverse events in the emergency department (ED). Objectives This study compared the ability of trigger tool and reporting methods to capture adverse events in the ED and investigated the characteristics of the adverse events identified by each. Methods This 1-year prospective observational cohort study evaluated a monitoring system that combined 2 reporting methods and 5 trigger tool methods to capture adverse events in the ED of an academic medical center. Measurement outcomes included the number, type, and physical impact of the captured adverse events. Results Among 69,327 adult nontrauma ED visits, 285 adverse events were identified. Of these adverse events, 77.2% were identified using reporting methods, 26% using trigger tool methods, and 3.2% using both methods. Most patients (81.7%) incurred temporary, minor physical impacts. Of the adverse events that occurred, 86.7% were related to clinical performance. Compared with reporting methods, trigger tool methods had a lower positive predictive rate to identify adverse events (odds ratio [OR], 0.1; 95% confidence interval [CI], 0.09–0.16), a greater proportion of adverse events occurring during the preinterventation and postintervention phases (OR, 17.0; 95% CI, 8.48–34.16), and more cases of severe physical impact or death (OR, 5.4; 95% CI, 2.62–11.10). Conclusions The reporting methods more effectively captured greater numbers of adverse events, whereas the adverse events captured by the trigger tool methods were more likely to be severe physical impacts. The combined use of the different methods had synergistic benefits for monitoring adverse events in the ED.
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Alshyyab MA, FitzGerald G, Dingle K, Ting J, Bowman P, Kinnear FB, Borkoles E. Developing a conceptual framework for patient safety culture in emergency department: A review of the literature. Int J Health Plann Manage 2018; 34:42-55. [PMID: 30187536 DOI: 10.1002/hpm.2640] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 08/01/2018] [Indexed: 11/08/2022] Open
Abstract
Patient safety culture is a critical component of modern health care. However, the high-paced, unpredictable nature of the emergency department (ED) environment may impact adversely on it. The aim of this paper is to explore the concept of patient safety culture as it may apply to emergency health care, and to propose a conceptual framework that could form the basis for interventions designed to improve it. This is a systematic review of the literature. A search was undertaken of common electronic bibliographic databases using key words such as safety culture, safety climate, and Emergency Department. Articles were analysed for consistent themes with the aim to construct a conceptual framework. Ten articles met the inclusion criteria that specifically examined safety culture in the ED. Synthesis of the literature resulted in the emergence of three overarching themes of ED practice found to impact on safety culture in the ED. These were the dimensions of patient safety culture, the factors influencing it, and the interventions for improving it. A conceptual framework was constructed that identifies elements that significantly impact the patient safety culture in the ED. This framework may assist managers and researchers to take a comprehensive approach to build an effective safety culture in ED setting.
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Affiliation(s)
- Muhammad Ahmed Alshyyab
- School of Public Health and Social Work and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Gerard FitzGerald
- School of Public Health and Social Work and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Kaeleen Dingle
- School of Public Health and Social Work and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Joseph Ting
- School of Public Health and Social Work and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia.,Department of Emergency Medicine, Mater Health Services, Brisbane, QLD, Australia
| | - Paula Bowman
- School of Public Health and Social Work and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Frances B Kinnear
- School of Public Health and Social Work and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia.,Department of Emergency Medicine, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Erika Borkoles
- School of Public Health and Social Work and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
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Lord K, Parwani V, Ulrich A, Finn EB, Rothenberg C, Emerson B, Rosenberg A, Venkatesh AK. Emergency department boarding and adverse hospitalization outcomes among patients admitted to a general medical service. Am J Emerg Med 2018; 36:1246-1248. [PMID: 29605480 DOI: 10.1016/j.ajem.2018.03.043] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 03/19/2018] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Overcrowding in the emergency department (ED) has been associated with patient harm, yet little is known about the association between ED boarding and adverse hospitalization outcomes. We sought to examine the association between ED boarding and three common adverse hospitalization outcomes: rapid response team activation (RRT), escalation in care, and mortality. METHOD We conducted an observational analysis of consecutive patient encounters admitted from the ED to the general medical service between February 2013 and June 2015. This study was conducted in an urban, academic hospital with an annual adult ED census over 90,000. We defined boarding as patients with greater than 4h from ED bed order to ED departure to hospital ward. The primary outcome was a composite of adverse outcomes in the first 24h of admission, including RRT activation, care escalation to intensive care, or in-hospital mortality. RESULTS A total of 31,426 patient encounters were included of which 3978 (12.7%) boarded in the ED for 4h or more. Adverse outcomes occurred in 1.92% of all encounters. Comparing boarded vs. non-boarded patients, 41 (1.03%) vs. 244 (0.90%) patients experienced a RRT activation, 53 (1.33%) vs. 387 (1.42%) experienced a care escalation, and 1 (0.03%) vs.12 (0.04%) experienced unanticipated in-hospital death, within 24h of ED admission. In unadjusted analysis, there was no difference in the composite outcome between boarding and non-boarding patients (1.91% vs. 1.91%, p=0.994). Regression analysis adjusted for patient demographics, acuity, and comorbidities also showed no association between boarding and the primary outcome. A sensitivity analysis showed an association between ED boarding and the composite outcome inclusive of the entire inpatient hospital stay (5.8% vs. 4.7%, p=0.003). CONCLUSION Within the first 24h of hospital admission to a general medicine service, adverse hospitalization outcomes are rare and not associated with ED boarding.
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Affiliation(s)
- Kito Lord
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, United States.
| | - Vivek Parwani
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, United States.
| | - Andrew Ulrich
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, United States.
| | - Emily B Finn
- Center for Healthcare Innovation, Redesign and Learning, Yale University, New Haven, CT, United States.
| | - Craig Rothenberg
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, United States.
| | - Beth Emerson
- Center for Healthcare Innovation, Redesign and Learning, Yale University, New Haven, CT, United States; Section of Pediatric Emergency Medicine, Department of Pediatrics, Yale University School of Medicine, New Haven, CT, United States.
| | - Alana Rosenberg
- Center for Healthcare Innovation, Redesign and Learning, Yale University, New Haven, CT, United States.
| | - Arjun K Venkatesh
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, United States; Center for Outcomes Research and Evaluation, Yale University School of Medicine, New Haven, CT, United States.
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Taylor D, Upadhyay UD, Fjerstad M, Battistelli MF, Weitz TA, Paul ME. Standardizing the classification of abortion incidents: the Procedural Abortion Incident Reporting and Surveillance (PAIRS) Framework. Contraception 2017; 96:1-13. [PMID: 28578150 DOI: 10.1016/j.contraception.2017.05.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 04/30/2017] [Accepted: 05/14/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To develop and validate standardized criteria for assessing abortion-related incidents (adverse events, morbidities, near misses) for first-trimester aspiration abortion procedures and to demonstrate the utility of a standardized framework [the Procedural Abortion Incident Reporting & Surveillance (PAIRS) Framework] for estimating serious abortion-related adverse events. STUDY DESIGN As part of a California-based study of early aspiration abortion provision conducted between 2007 and 2013, we developed and validated a standardized framework for defining and monitoring first-trimester (≤14weeks) aspiration abortion morbidity and adverse events using multiple methods: a literature review, framework criteria testing with empirical data, repeated expert reviews and data-based revisions to the framework. RESULTS The final framework distinguishes incidents resulting from procedural abortion care (adverse events) from morbidity related to pregnancy, the abortion process and other nonabortion related conditions. It further classifies incidents by diagnosis (confirmatory data, etiology, risk factors), management (treatment type and location), timing (immediate or delayed), seriousness (minor or major) and outcome. Empirical validation of the framework using data from 19,673 women receiving aspiration abortions revealed almost an equal proportion of total adverse events (n=205, 1.04%) and total abortion- or pregnancy-related morbidity (n=194, 0.99%). The majority of adverse events were due to retained products of conception (0.37%), failed attempted abortion (0.15%) and postabortion infection (0.17%). Serious or major adverse events were rare (n=11, 0.06%). CONCLUSIONS Distinguishing morbidity diagnoses from adverse events using a standardized, empirically tested framework confirms the very low frequency of serious adverse events related to clinic-based abortion care. IMPLICATIONS The PAIRS Framework provides a useful set of tools to systematically classify and monitor abortion-related incidents for first-trimester aspiration abortion procedures. Standardization will assist healthcare providers, researchers and policymakers to anticipate morbidity and prevent abortion adverse events, improve care metrics and enhance abortion quality.
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Affiliation(s)
- Diana Taylor
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, and School of Nursing, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94612.
| | - Ushma D Upadhyay
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics Gynecology and Reproductive Sciences, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94612
| | - Mary Fjerstad
- National Abortion Federation, 1090 Vermont Avenue NW #1000, Washington, DC 20005
| | - Molly F Battistelli
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics Gynecology and Reproductive Sciences, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94612
| | - Tracy A Weitz
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics Gynecology and Reproductive Sciences, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94612
| | - Maureen E Paul
- Beth Israel Deaconess Medical Center, Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215
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Bergs J, Vandijck D, Hoogmartens O, Heerinckx P, Van Sassenbroeck D, Depaire B, Marneffe W, Verelst S. Emergency department crowding: Time to shift the paradigm from predicting and controlling to analysing and managing. Int Emerg Nurs 2017; 24:74-7. [PMID: 27170954 DOI: 10.1016/j.ienj.2015.05.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Venkatesh AK, Goodrich K. Emergency care and the national quality strategy: highlights from the Centers for Medicare & Medicaid Services. Ann Emerg Med 2014; 65:396-9. [PMID: 25128008 DOI: 10.1016/j.annemergmed.2014.07.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 06/10/2014] [Accepted: 07/07/2014] [Indexed: 10/24/2022]
Abstract
The Centers for Medicare & Medicaid Services (CMS) of the US Department of Health and Human Services seeks to optimize health outcomes by leading clinical quality improvement and health system transformation through a variety of activities, including quality measure alignment, prioritization, and implementation. CMS manages more than 20 federal quality measurement and public reporting programs that cover the gamut of health care providers and facilities, including both hospital-based emergency departments (EDs) and individual emergency physicians. With more than 130 million annual visits, and as the primary portal of hospital admission, US hospital-based EDs deliver a substantial portion of acute care to Medicare beneficiaries. Given the position of emergency care across clinical conditions and between multiple settings of care, the ED plays a critical role in fulfilling all 6 priorities of the National Quality Strategy. We outline current CMS initiatives and future opportunities for emergency physicians and EDs to effect each of these priorities and help CMS achieve the triple aim of better health, better health care, and lower costs.
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Affiliation(s)
- Arjun K Venkatesh
- Robert Wood Johnson Foundation Clinical Scholars Program and Department of Emergency Medicine, Yale School of Medicine, New Haven, CT.
| | - Kate Goodrich
- Center for Clinical Standards and Quality, Centers for Medicare & Medicaid Services, Baltimore, MD, and Division of Hospital Medicine, Department of Medicine, George Washington University School of Medicine, Washington, DC
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Tomas-Vecina S, Chanovas-Borrás MR, Roqueta-Egea F, Toranzo-Cepeda T. Measuring Patient Safety in the Emergency Department: The Spanish Experience. Am J Med Qual 2014; 29:362-3. [PMID: 25030532 DOI: 10.1177/1062860614526635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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