The introduction of a safety checklist in two UK hospital emergency departments: A qualitative study of implementation and staff use.

Tracey Stone,Emma Redfern,Heather Brant,Joanna Kesten,Jon Banks,Ann Remmers,Sabi Redwood

doi:10.1111/jocn.15184

Abstract

Aims and objectivesTo explore the extent to which a checklist designed to support patient safety in hospital Emergency Departments was recognised and used by staff.BackgroundPatient crowding in UK Emergency Departments makes it difficult for staff to monitor all patients for signs of clinical deterioration. An Emergency Department Safety Checklist was developed at a UK hospital to ensure patients are regularly monitored. It was subsequently implemented in six hospitals and recommended for use across the National Health Service in England.MethodsThis was a qualitative study in two UK hospital Emergency Departments. Data collection consisted of sixty‐six hours of nonparticipant observation and interviews with twenty‐six staff. Observations were sampled across different days and times. Interviews sampled a range of staff. Data were analysed thematically. The study was undertaken in accordance with COREQ guidelines.ResultsStaff described the Emergency Department Safety Checklist as a useful prompt and reminder for monitoring patients' vital signs and other aspects of care. It was also reported as effective in communicating patient care status to other staff. However, completing the checklist was also described as a task which could be overlooked during busy periods. During implementation, the checklist was promoted to staff in ways that obscured its core function of maintaining patient safety.ConclusionsThe Emergency Department Safety Checklist can support staff in maintaining patient safety. However, it was not fully recognised by staff as a core component of everyday clinical practice.Relevance to clinical practiceThe Emergency Department Safety Checklist is a response to an overcrowded environment. To realise the potential of the checklist, emergency departments should take the following steps during implementation: (a) focus on the core function of clinical safety, (b) fully integrate the checklist into the existing workflow and (c) employ a departmental team‐based approach to implementation and training.

Highlights

The UK, and other countries, have seen an unprecedented increase in demand for Emergency Department (ED) services in recent years (Di Somma et al, 2015; Maguire, Dunn, & McKenna, 2016)
It was notable that staff prioritised completion of the clinical observations chart while documenting those actions on the ED Safety Checklist was seen as the expendable element when busy: section below, we explore the relationship between the implementation strategies used and the impact on the perception and take-up of the checklist
Staff valued the individual contact, but the ED Safety Checklist became associated with one individual who felt under pressure to fulfil the implementation of the checklist with little available support from senior staff: I had a little presentation so it was just sort of ad-hoc where we were not too busy just grabbing a couple or one

Summary

Introduction

The UK, and other countries, have seen an unprecedented increase in demand for Emergency Department (ED) services in recent years (Di Somma et al, 2015; Maguire, Dunn, & McKenna, 2016) This has led to crowding where the number of patients exceeds the capacity for which an ED is designed and resourced (Royal College of Emergency Medicine, 2015). Most vital sign measurements on the checklist are required hourly or more frequently if clinically indicated These aspects of care are established elements of clinical practice, but during times of crowding in the ED staff find it difficult to meet competing demands (Royal College of Emergency Medicine, 2015). It is intended to support temporary staff who are increasingly required to work in EDs as the established ED workforce numbers are no longer sufficient to meet the demand (Evans & Ward, 2017)

Methods

Discussion

Conclusion