Safety Of Emergency Care Research Articles

The Emergency nurse Protocols Initiating Care—Sydney Triage to Admission Risk Tool (EPIC-START) trial: protocol for a stepped wedge implementation trial

IntroductionEmergency department (ED) overcrowding is a global problem and a threat to the quality and safety of emergency care. Providing timely and safe emergency care therein is challenging. To address this in New South Wales (NSW), Australia, the Emergency nurse Protocol Initiating Care—Sydney Triage to Admission Risk Tool (EPIC-START) was developed. EPIC-START is a model of care incorporating EPIC protocols, the START patient admission prediction tool, and a clinical deterioration tool to support ED flow, timely care, and patient safety. The aim of this study is to evaluate the impact of EPIC-START implementation across 30 EDs on patient, implementation, and health service outcomes.Methods and analysisThis study protocol adopts an effectiveness-implementation hybrid design (Med Care 50: 217-226, 2012) and uses a stepped–wedge cluster randomised control trial of EPIC-START, including uptake and sustainability, within 30 EDs across four NSW local health districts spanning rural, regional, and metropolitan settings. Each cluster will be randomised independently of the research team to 1 of 4 dates until all EDs have been exposed to the intervention. Quantitative and qualitative evaluations will be conducted on data from medical records and routinely collected data, and patient, nursing, and medical staff pre- and post-surveys.Ethics and disseminationEthical approval for the research was received from the Sydney Local Health District Research Ethics Committee (Reference Number 2022/ETH01940) on 14 December 2022.Trial registrationAustralian and New Zealand Clinical trial, ACTRN12622001480774p. Registered on 27 October 2022.

Improving the Quality of Emergency Intrahospital Transport for Critically Ill Patients by Using Toyota Production System Methods.

ObjectiveTo explore the effects of the Toyota Production System (TPS) for improving the quality of emergency intrahospital transport for critically ill patients in management.MethodsBetween April and June 2021, 68 critically ill patients were transported to corresponding wards, while 63 critically ill patients were transported to corresponding wards between July and September 2021. The pre-TPS and post-TPS management groups each included 30 cases based on their propensity score. The TPS management tool was combined with the PDCA method for analysing the current situation as well as determining the target for improvement, calculating the value and process efficiencies, and modifying and evaluating relevant processes. At last, the changes in transport time, receiving department, patient satisfaction, and adverse event rate of critically ill patients after TPS management were analysed.ResultsThe total intrahospital transport time of critically ill patients decreased from 39 minutes (median) before the implementation of TPS management to 27 minutes (median) after TPS management, and the difference was statistically significant (P<0.05). Process efficiency and value efficiency both increased from 33.33% and 38.46% before TPS management to 42.86% and 40.74% after TPS management, respectively. Likewise, the satisfaction of receiving departments and patients increased from 73.33% and 76.67% before TPS management to 96.67% and 96.67% after TPS management (P<0.001). Finally, the adverse event rate decreased as a result of TPS management from 13.33% to 3.33% (P>0.05).ConclusionTPS management may significantly shorten the intrahospital transport time for critically ill patients, reduce the occurrence of adverse events in emergency care, advance patient satisfaction, and improve the overall quality and safety of emergency care.

Framing trauma leaders’ request in emergency care interactions

A team leader’s request is a crucial factor for successful team interaction to ensure patient safety in emergency care. This study examines how team leaders accomplish and frame immediate requests through language use and corresponding eye-movement patterns in emergency care simulation, focusing on when the team is led by a senior doctor (SD) and when it is led by a junior doctor (JD). The team included two foundation doctors, who are in their first two years in medical practice, two emergency department (ED) nurses and one ED expert. They were recorded undertaking separate simulated operations on a simulated patient, and the team leader wore eye-tracking glasses. Interactional linguistic and multimodal analyses of video, audio and eye-movement data revealed that SD made immediate requests to the team members with multimodal emphasis – i.e., gazed at the recipients and addressed them verbally, especially when asking for recipients’ actions – while JD often used only gaze in requesting such actions. Although our study has limitations in terms of the small size of the data, the findings nevertheless highlight that the leader’s requesting was framed and ascribed in the continuum from a question to an instruction through co-construction of joint action with recipients in the social interaction.

A Framework Proposal for Quality and Safety Measurement in Gynecologic Emergency Care.

To define and assess the prevalence of potentially life-threatening gynecologic emergencies among women presenting for acute pelvic pain for the purpose of developing measures to audit quality of care in emergency departments. We conducted a mixed-methods multicenter study at gynecologic emergency departments in France and Belgium. A modified Delphi procedure was first conducted in 2014 among health care professionals to define relevant combinations of potentially life-threatening conditions and near misses in the field of gynecologic emergency care. A prospective case-cohort study in the spring of 2015 then assessed the prevalence of these potentially life-threatening emergencies and near misses among women of reproductive age presenting for acute pelvic pain. Women in the case group were identified at 21 participating centers. The control group consisted of a sample of women hospitalized for acute pelvic pain not caused by a potentially life-threatening condition and a 10% random sample of outpatients. Eight gynecologic emergencies and 17 criteria for near misses were identified using the Delphi procedure. Among the 3,825 women who presented for acute pelvic pain, 130 (3%) were considered to have a potentially life-threatening condition. The most common diagnoses were ectopic pregnancies with severe bleeding (n=54; 42%), complex pelvic inflammatory disease (n=30; 23%), adnexal torsion (n=20; 15%), hemorrhagic miscarriage (n=15; 12%), and severe appendicitis (n=6; 5%). The control group comprised 225 hospitalized women and 381 outpatients. Diagnostic errors occurred more frequently among women with potentially life-threatening emergencies than among either hospitalized (odds ratio [OR] 1.7, 95% CI 1.1-2.7) or outpatient (OR 14.7, 95% CI 8.1-26.8) women in the control group. Of the women with potentially life-threatening conditions, 26 met near-miss criteria compared with six with not potentially life-threatening conditions (OR 25.6, 95% CI 10.9-70.7). Potentially life-threatening gynecologic emergencies are high-risk conditions that may serve as a useful framework to improve quality and safety in emergency care.

Using problem-based learning to improve patient safety in the emergency department.

Pressures from rising patient numbers and overcrowding in emergency departments (EDs) are putting patients' safety at risk. Beyond improved provision of resources, two elements are essential to patient safety in emergency care - work culture and staff training. In traditional training environments, the teacher dispenses knowledge to nursing students in a classroom setting. However, problem-based learning (PBL) and the related concept of team-based learning (TBL) aim to enhance learners' knowledge and skills in non-technical subjects, such as patient safety, as well as their ability to address challenges they encounter in clinical practice. This article explores the theories that underpin PBL and TBL and discusses how they can be used by nurse educators to motivate staff and improve patient safety in the ED.

A Broader View of Quality: Choosing Wisely Recommendations From Other Specialties With High Relevance to Emergency Care

The American College of Emergency Physicians (ACEP) joined the Choosing Wisely campaign in 2013 and has contributed 10 recommendations to reduce low-value care. Recommendations from other specialties may also identify opportunities to improve quality and patient safety in emergency care. The Choosing Wisely work group of the ACEP Quality and Patient Safety Committee seeks to identify and characterize the Choosing Wisely recommendations from other professional societies with the highest relevance to emergency care. In June 2016, all Choosing Wisely recommendations from other specialties were obtained from the American Board of Internal Medicine Foundation. Using a modified Delphi method, the 10 group members rated recommendations for relevance on a validated 7-point scale. Recommendations identified as highly relevant (median score=7) were rated on 3 additional characteristics: cost savings (1=large, 5=none), risk-benefit profile (1=benefit >risk, 5=risk >benefit), and actionability by emergency physicians (1=complete, 5=none). Results are presented as overall means (eg, mean of subcategory means) and subcategory means with SDs. Initial review of 412 recommendations identified 49 items as highly relevant to emergency care. Eleven were redundant with ACEP recommendations, leaving 38 items from 25 professional societies. Overall means for items ranged from 1.57 to 3.1. Recommendations' scores averaged 3.2 (SD 0.6) for cost savings, 1.9 (SD 0.4) for risk-benefit, and 1.6 (SD 0.5) for actionability. The most common conditions in these recommendations were infectious diseases (14 items; 37%), head injury (4 items; 11%), and primary headache disorders (4 items; 11%). The most frequently addressed interventions were imaging studies (11 items; 29%) and antibiotics (9 items; 24%). Thirty-eight Choosing Wisely recommendations from other specialties are highly relevant to emergency care. Imaging studies and antibiotic use are heavily represented among them.

Emergency patients' and family members' experiences of encountering care providers and receiving care in nonconveyance situations.

Not much research has been conducted on emergency patients' and family members' experiences of encountering care providers and receiving care in nonconveyance situations. This knowledge is required to develop the quality and safety of emergency care. The aim of the study was to describe patients' and family members' experiences concerning encounters with emergency care providers and the patient's care in nonconveyance situations. The study is a descriptive, cross-sectional survey carried out using quantitative methods. Statistical data were analysed using SPSS Statistics for Windows. The responses to an open question were analysed using inductive content analysis. Patients and family members found that emergency care providers had acted in a professional and friendly manner. They would have expected more psychological support. Family members were less satisfied with the emergency care than patients, especially as regards psychological support and the amount of time given to the patient. Emergency care providers should take the whole family's situation into consideration and seek to promote the family's coping by providing comprehensible counselling and support.

PROPOSTA DE PASSOS PARA A SEGURANÇA DO PACIENTE NO ATENDIMENTO PRÉ-HOSPITALAR MÓVEL

RESUMO Objetivo: propor passos para a segurança do paciente a partir da análise dos riscos no atendimento pré-hospitalar móvel sob a ótica dos enfermeiros. Método: estudo quantitativo, e descritivo. Amostra intencional, composta por 23 enfermeiros. Utilizou-se o método de pesquisa fotográfica para identificar os riscos à segurança do paciente em um Serviço de Atendimento Móvel de Urgência de uma cidade do Rio Grande do Norte. A coleta foi realizada de março a junho de 2012 e organizada em cinco etapas: obtenção das fotos de situações de segurança e não segurança; seleção de fotos pela qualidade de imagem; seleção de fotos pelos experts da temática; seleção de dez imagens de modo aleatório; e aplicação do instrumento de análise das fotos pelos profissionais. Foi utilizada a análise de conteúdo e análise descritiva. Resultados: os riscos apontados no estudo foram: dificuldades no acondicionamento de equipamentos e materiais; especificidades do trabalho no atendimento pré-hospitalar móvel; risco de infecção; risco de traumas; e dificuldades na administração de medicamentos. A partir dessas informações e confrontos com a literatura, foram sugeridos dez passos para a segurança do paciente no atendimento pré-hospitalar, voltados às necessidades de redução dos riscos apresentados. Conclusão: a análise de riscos e proposta de intervenções para a segurança do paciente favorecem a qualidade do atendimento em saúde, com benefícios na esfera: paciente, equipe, profissional e ambiente. Sugere-se que sejam desenvolvidas de acordo com as necessidades de cada serviço.

Quality and Safety of Emergency Care in Inpatient Facilities in Russia

Quality and Safety of Emergency Care in Inpatient Facilities in Russia

Know me - A new person-centered approach for dementia-friendly emergency department care.

A visit to an emergency department can be a disorientating experience for someone with dementia. Empowered caregivers can mitigate harm stemming from communication issues to support a successful emergency department visit. A qualitative study determined the feasibility of the structure, format, and content of eight hospital-readiness communication tools. Data collection involved English and French-language caregiver focus groups in two Canadian provinces. Study findings have the potential to (a) improve safety in emergency care to older people with dementia and their caregivers, and (b) offer cost-effective communication tools for web-based knowledge translation activity in acute care.

Construction and content validation of checklist for patient safety in emergency care.

To construct and validate a checklist for patient safety in emergency care. This is methodological research conducted in Curitiba, in 2015, with construction and validation stages. The checklist was based on the guidelines of the Brazilian patient safety programme and validated online using the Delphi method, with a questionnaire, and with the participation of 23 Brazilian specialists in the first round and 20 in the second round. The data were analysed using the Content Validity Index (CVI), Cronbach's α, and Fisher's Exact Test. We produced a checklist with 18 valid and reliable items (94% of CVI, Cronbach's α = 0.91). The checklist comprises patient safety actions and items to predict risk situations, corrective actions, and promote safety in emergency services and other health-related contexts.

Improving the governance of patient safety in emergency care: a systematic review of interventions

ObjectivesTo systematically review interventions that aim to improve the governance of patient safety within emergency care on effectiveness, reliability, validity and feasibility.DesignA systematic review of the literature.MethodsPubMed, EMBASE, Cumulative Index...

The safety of emergency medicine

The patient safety movement has been active for over a decade, but the issue of patient safety in emergency care and the emergency department (ED) has only recently been brought...

Procedural Safety in Emergency Care: A Conceptual Model and Recommendations

Procedural Safety in Emergency Care: A Conceptual Model and Recommendations

Using Information Technology to Improve the Quality and Safety of Emergency Care

With the 2010 federal health care reform passage, a renewed focus has emerged for the integration of electronic health records (EHRs) into the U.S. health care system. A consensus conference in October 2009 met to discuss the future research agenda with regard to using information technology (IT) to improve the future quality and safety of emergency department (ED) care. The literature is mixed as to how the use of computerized provider order entry (CPOE), clinical decision support (CDS), EHRs, and patient tracking systems has improved or degraded the safety and quality of ED care. Such mixed findings must be considered in the national push for rapid implementation of health IT. We present a research agenda addressing the major questions that are posed by the introduction of IT into ED care; these questions relate to interoperability, patient flow and integration into clinical work, real-time decision support, handoffs, safety-critical computing, and the interaction between IT systems and clinical workflows.

Conceptual Framework for Studying Shift Changes and other Transitions in Care

In healthcare systems, division of labor and the need for continuous, 24 hour care subjects patients to multiple transitions in care. These transitions, or turnovers, are potential points of failure but have not been intensively studied. We observed care transitions in 5 EDs as part of a study on safety in emergency care and found that very different sorts of handovers occur in different settings. Based on these observations, we propose a conceptual framework for characterizing turnover events. The ability to characterize certain types of transitions may help clarify future studies and assist in crafting interventions to the context of work.

Transitions in Care: Signovers in the Emergency Department

The need for 24-hour emergency care requires emergency department (ED) staff to work in shifts. We observed shift transitions in 5 EDs as part of a study on safety in emergency care. We found the observable characteristics of shift transitions to be highly variable across institutions and dynamically variable within shift change episodes. However, across all sites, turnovers were interactional rather than transactional, and were highly tailored to the immediate context. The high degree of situatedness in the turnovers suggest they are not likely to be adapted to a standardized tool or protocol.

Shift Changes among Emergency Physicians: Best of Times, Worst of Times

The need for 24-hour emergency care requires emergency department (ED) staff to work in shifts. Shift changes have long been viewed as risky times, for failures in the transfer of information, authority, or responsibility care can result in adverse events. We observed shift transitions in the ED as part of a study on safety in emergency care. We found that, in addition to being an expected point of failure, transitions were also, unexpectedly, associated with recovery from failure. We report two illustrative case studies, and examine implications for strategies aimed at reducing the number of and volume of transitions.

Setting the educational agenda and curriculum for error prevention in emergency medicine.

Graduate and postgraduate medical education currently teaches safety in patient care by instilling a deep sense of personal responsibility in student practitioners. To increase safety, medical education will have to begin to introduce new concepts from the "safety sciences," without losing the advantages that the values of commitment and responsibility have gained. There are two related educational goals. First, we in emergency medicine (EM) must develop a group of safety-educated practitioners who can understand and implement safe practice innovations in their clinical settings, and will be instrumental in changing our professional culture. Second, EM must develop a group of teachers and researchers who can begin to deeply understand how safety is maintained in emergency care, develop solutions that will work in emergency department settings, and pass on those insights and innovations. The specifics of what should be taught are outlined briefly. Work is currently ongoing to identify more specifically the core content that should be included in educational programs on patient safety in emergency care. Finally, careful attention will have to be paid to the way in which these principles are taught. It seems unlikely that a series of readings and didactic lectures alone will be effective. The analysis of meaningful cases, perhaps supplemented by high-fidelity simulation, seems to hold promise for more successful education in patient safety.