Emergency Physician Perceptions of Patient Safety Risks
Received 18 June 2009; received in revised form 9 July 2009; accepted 4 August 2009. published online 26 October 2009. Corrected Proof
Study objective
Although national standards to address patient safety exist, their relevance to emergency department (ED) patient safety is unclear. We survey practicing emergency physicians to assess their perceptions of the relative importance of patient safety concerns and how these varied by urban/rural location and practice characteristics.
Methods
We developed and analyzed electronically collected survey data that assessed emergency physician perceptions of patient safety risks. American College of Emergency Physicians (ACEP) members rated 16 patient safety concerns with a 5-point Likert scale.
Results
Of 2,507 emergency physician respondents, 1,114 (44%) practiced in urban, 1,056 (42%) in suburban, and 337 (13%) in rural settings. Crowding from inpatient boarding (mean Likert scale score 4.3), availability of specialty consultation (mean 4.1), and nursing shortages (mean 3.9) were the greatest concerns. Rural respondents ranked consultant availability (mean 4.3), lack of follow-up after ED care (mean 3.8), and nurse shortages (mean 3.8) as top concerns. Crowding was the greatest concern for suburban (mean 4.3) and urban emergency physicians (mean 4.5) but was ranked seventh by rural emergency physicians (mean 3.5). Crowding was perceived as a greater problem as hospital size, ED volume, and the percentage of patients who left without being seen increased, regardless of practice location.
Conclusion
In this sample of practicing emergency physicians, rural emergency physicians' patient safety concerns differ from those of their urban/suburban counterparts. For urban/suburban emergency physicians, crowding is the greatest safety concern; for rural emergency physicians, consultant availability was the greatest concern. Emergency physicians' greatest concerns are not routinely measured and reported as part of national patient safety benchmarking programs.
aUniversity of New Mexico, Department of Emergency Medicine, Albuquerque, NM
bAmerican College of Emergency Physicians, Irving, TX, Albuquerque, NM
Address for correspondence: Cameron S. Crandall, MD, Department of Emergency Medicine, MSC10 5560, 1 University of New Mexico, Albuquerque, NM 87131-0001; 505-272-5062, fax 505-272-6503
Supervising editor: Robert L. Wears, MD, MS
Author contributions: All authors conceived the study and developed the design. DPS, CSC, and RC worked with ACEP to develop the electronic data collection form. RC oversaw data collection. CSC conducted the statistical analysis. DPS, CSC, and TZ contributed to writing the article. All authors take 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. The authors have stated that no such relationships exist. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement.
ABSTRACT