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Study objectiveWell-functioning systems are critical to safe patient care, but little is known about the status of such systems in US health care facilities, including high-risk settings such as the emergency department (ED). The purpose of this study is to assess the degree to which EDs are designed, managed, and supported in ways that ensure patient safety. MethodsThis was a validated, psychometrically tested survey of clinicians working in 65 US EDs that assessed clinician perceptions about the EDs' physical environment, staffing, equipment and supplies, nursing, teamwork, safety culture, triage and monitoring, information coordination and consultation, and inpatient coordination. ResultsOverall 3,562 eligible respondents completed the survey (response rate=66%). Survey respondents commonly reported problems in 4 systems critical to ED safety: physical environment, staffing, inpatient coordination, and information coordination and consultation. ED clinicians reported that there was insufficient space for the delivery of care most (25%) or some (37%) of the time. Respondents indicated that the number of patients exceeded ED capacity to provide safe care most (32%) or some of the time (50%). Only 41% of clinicians indicated that most of the time specialty consultation for critically ill patients arrived within 30 minutes of being contacted. Finally, half of respondents reported that ED patients requiring admission to the ICU were rarely transferred from the ED to the ICU within 1 hour. ConclusionReports by ED clinicians suggest that substantial improvements in institutional design, management, and support for emergency care are necessary to maximize patient safety in US EDs. a Institute for Health Research, Kaiser Permanente Colorado and the Departments of Emergency Medicine and Preventive Medicine and Biometrics, University of Colorado Health Sciences Center, Denver, CO b Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA c Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA d Biostatistics Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA e Institute for Health Policy, Massachusetts General Hospital, Boston, MA f Yale School of Public Health, Yale School of Medicine, New Haven, CT g Weill Medical College of Cornell University and New York–Presbyterian Hospital, New York, NY h Department of Health Care Policy, Harvard Medical School, Boston, MA
Provide feedback on this article at the journal's Web site, www.annemergmed.com. Supervising editor: Robert L. Wears, MD, MS Author contributions: All authors take responsibility for the accuracy of the paper. DJM takes responsibility for the paper as a whole. Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article, that might create any potential conflict of interest. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. This project was supported by grant number 5 R01 HS013099 from the Agency for Healthcare Research and Quality. The Agency for Healthcare Research and Quality had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or in the preparation, review, or approval of the article. All of the authors have participated sufficiently in the work to take public responsibility for the content and have no financial arrangement with a company that makes a product or makes a competing product discussed in the article. Reprints not available from the authors. Publication date: Available online December 3, 2008. PII: S0196-0644(08)01863-5 doi:10.1016/j.annemergmed.2008.10.007 © 2008 Published by Elsevier Inc.
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ABSTRACT
The Safety of Emergency Care Systems: Results of a Survey of Clinicians in 65 US Emergency Departments