Staff Working In Emergency Departments Research Articles

Influence of job satisfaction components on staff performance in the emergency department

Background/Aims The relationship between job satisfaction and job performance has been well-established in healthcare research. This study aimed to measure job satisfaction and performance among staff working in emergency departments in Jordan, and to explore the association between these two variables, focusing on the different components of job satisfaction. Methods A cross-sectional design with a convenience sampling approach was used, recruiting 286 staff working across 11 emergency departments in Jordan. Participants completed a questionnaire comprising validated scales to measure job satisfaction and job performance. Descriptive statistics, Pearson correlation, Cronbach's alpha and multiple regression analysis were used, via the SPSS version 25, to explore the relationship between job performance and different components of job satisfaction. Results Mean scores on the job satisfaction and job performance scales indicated that participants were neither satisfied nor dissatisfied with their jobs, but had high perceived job performance levels. Multiple regression showed a significant positive relationship between three job satisfaction dimensions (colleagues' communication and relationship: B=0.16; physical environment and workplace safety: B=0.28; supervisor support: B=0.17) and perceived job performance (P<0.001). There was a small but insignificant association between job performance and the compensation and promotion dimension of job satisfaction (B=−0.05, P=0.192). Conclusions This study supports previous evidence indicating that job satisfaction is positively linked with job performance, although compensation and promotion may not be a strong predictor of job performance in an emergency department context. Overall, these findings highlight the importance of strategies to improve job satisfaction among healthcare professionals.

Intersectional characterization of emergency department (ED) staff experiences of racism: a survey of ED healthcare workers for the Disrupting Racism in Emergency Medicine (DRiEM) Investigators.

The impact of racism on patient outcomes in Emergency Medicine has been examined but there have been few studies exploring the experiences of racism in health care workers. This survey aims to explore the experience of racism by interdisciplinary staff in a tertiary ED. By characterizing the staff experience of racism in the ED, we hope to inform the design of strategies to disrupt racism and ultimately improve the health and wellness of both staff and patients. We conducted a self-administered, cross-sectional survey to explore the reported experience of racism by healthcare workers in a single urban ED in an academic trauma centre. We employed classification and regression tree analyses to evaluate predictors of racism through an intersectional lens. A majority (n = 200, 75%) of all ED staff reported experiencing interpersonal racism (including physical violence, direct verbal violence, mistreatment and/or microaggressions) in the workplace. Respondents who identified as racialized self-reported significantly more racism at work than white respondents (86% vs. 63%, p < 0.001). Occupation, race, migrant status and age were identified through intersectional machine-learning models to be significantly predictive of the experience of racism. Nearly all respondents felt that the disruption of racism in Emergency medicine is important to them (90%, n = 207) and (93%, n = 214) were willing to participate in further training in anti-racism. Racism against interdisciplinary staff working in EDs is common and the burden on healthcare workers is high. Intersections of occupation, race, age and migrant status are uniquely predictive of the experience of racism for EM staff. Interventions to disrupt racism should be informed by intersectional considerations to create a safe working environment and target populations most at risk. ED healthcare workers are willing to take steps to disrupt racism in their workplace and need institutional support to do so.

Addressing a Key Leadership Challenge: Workplace Violence

Workplace violence is a growing concern among health care workers, especially staff working in emergency departments. Emergency department leaders have oversight accountability that includes mitigation of workplace violence risks and staff education related to workplace violence prevention. Challenges associated with workplace violence events include disruption of safe patient care, decreased staff job satisfaction, and increased turnover. Improving safety for staff, patients, and visitors requires a culture focused on safety. A summary of current regulations, standards, and resources available to date is provided, including a list of mitigation strategies that can be easily translated into practice by emergency nurse leaders.

Nursing Staff Knowledge on the Use of Intraosseous Vascular Access in Out-Of-Hospital Emergencies.

In healthcare practice, there may be critically injured patients in whom catheterisation of a peripheral venous access is not possible. In these cases, intraosseous access may be the preferred technique, using an intraosseous vascular access device (IOVA). Such devices can be used for infusion or administration of drugs in the same way as other catheterisations, which improves emergency care times, as it is a procedure that can be performed in seconds to a minute. The aim of this study was to analyse the level of knowledge of nursing staff working in emergency departments regarding the management of the intraosseous vascular access devices. To this end, a cross-sectional online study was carried out using an anonymous questionnaire administered to all professionals working in emergency and critical care units (ECCUs) in Granada district (Spain). The results show that 60% of the participants believe that with the knowledge they have, they would not be able to perform intraosseous vascular access, and 74% of the participants believe that the low use of this device is due to insufficient training. The obtained results suggest that the intraosseous access route, although it is a safe and quick way of achieving venous access in critical situations, is considered a secondary form of access because the knowledge of emergency and critical care professionals is insufficient, given the totality of the participants demanding more training in the management of intraosseous access devices. Therefore, the implementation of theoretical/practical training programmes related to intraosseous access (IO) could promote the continuous training of nurses working in ECCUs, in addition to improving the quality of care in emergency and critical care situations.

Development of a new job satisfaction scale for healthcare staff in emergency departments

Background/Aims Assessing factors that affect job satisfaction among healthcare staff, and formulating comprehensive strategies to improve job satisfaction, is fundamental to healthcare organisations. This study aimed to develop and validate a tool to measure staff job satisfaction in emergency departments of hospitals in Jordan. Methods The job satisfaction scale was developed using a literature review, instrument validation and statistical testing using exploratory factor analysis and Cronbach's alpha. A self-administered questionnaire was sent to 200 healthcare staff working in emergency departments in hospitals in Jordan between 14 April and 5 May 2020. Results A total of 112 respondents returned a completed questionnaire. Exploratory factor analysis yielded 16 strong explanatory items that affect job satisfaction, which could be grouped into four domains: physical environment and workplace safety; supervisor support; promotion and compensation; and communication and relationships with coworkers. The tool was found to have good reliability and validity. Low to moderate levels of satisfaction were found in most domains. Conclusions The findings of this study provide evidence for the psychometric properties of a newly developed scale to measure the level of job satisfaction of healthcare staff working in emergency departments.

Availability of patient information in the emergency department : Wish and reality

Fast access to information from other healthcare service providers is particularly important in emergency medicine, as the patients are often unknown and treatment decisions have to be made promptly. The study aims to identify the challenges that emergency departments face in obtaining information on patient history, the expected benefits of easier access to information and which information is most urgently needed. An online survey throughout Germany was carried out among medical staff working in emergency departments. In all, 181 questionnaires were fully completed and could be included in the data analysis. Of the respondents, 77.9% said it was difficult or very difficult to receive external data at the point of patient care. The survey participants estimate that they need an average of around 47 min to obtain information about one patient. 99.4% believe that patient care would benefit from an easier and faster information exchange. Medication lists, discharge letters, information on previous illnesses and allergies were classified as the most important data elements. There is an urgent need for action with regard to the considerable effort involved in obtaining information on emergency patients. Digital solutions such as the recently introduced emergency data set can offer additional value for clinical emergency care if they are widely used.

The pace of hospital life: A mixed methods study.

The pace-of-life hypothesis is a socio-psychological theory postulating that citizens of different cities transact the business of life at varying paces, and this pace is associated with a number of population level variables. Here we apply the pace-of-life hypothesis to a hospital context to empirically test the association between pace and patient and staff outcomes. As pressure on hospitals grow and pace increases to keep up with demand, is there empirical evidence of a trade-off between a rapid pace and poorer outcomes? We collected data from four large Australian hospitals, inviting all staff (clinical and non-clinical) to complete a survey, and conducted a series of observations of hospital staff's walking pace and transactional pace. From these data we constructed three measures of pace: staff perception of pace, transactional pace, and walking pace. Outcome measures included: hospital culture, perceived patient safety, and staff well-being outcomes of job satisfaction and burnout. Overall, participants reported experiencing a "fast-paced" "hurried" and "rapid" pace-of-life working in the Australian hospital sector. We found a significant difference in perceived pace across four hospital sites, similar to trends observed for transactional pace. This provides support that the pace-of-life hypothesis may apply to the hospital context. We tested associations between faster perceived pace, hospital culture, staff well-being and patient safety. Results revealed perceived faster pace significantly predicted negative perceptions of organizational culture, greater burnout and lower job satisfaction. However, perceived pace did not predict perceptions of patient safety. Different perceptions of hospital pace-of-life were found between different clinical settings and the type of care delivered; staff working in emergency departments reported significantly "faster-paced" work environments than staff working in palliative, aged care, or rehabilitation wards.

Effectiveness of interventions to reduce emergency department staff occupational stress and/or burnout: a systematic review.

The objective of this review was to synthesize the best evidence for the effectiveness of interventions to reduce occupational stress and/or burnout in the emergency department. The prevalence of occupational stress and burnout among busy emergency department staff requires urgent attention. This review summarizes the current evidence to provide recommendations on interventions to reduce occupational stress in the emergency department. Studies reporting on all health personnel working in emergency departments were included in the review. Any individual-focused or organizational-directed intervention was considered. Both published and unpublished studies including experimental and quasi-experimental studies were considered for inclusion in the review. The outcomes of interest included occupational stress, burnout, compassion fatigue, anxiety, and depression. A three-step search strategy was utilized to search seven databases (PubMed, CINAHL, Cochrane Central Register of Controlled Trials, Embase, Scopus, PsycINFO, Web of Science) and five gray literature resources (MedNar, Google Scholar, ProQuest Dissertations and Theses, Conference Proceedings). The search was limited to papers published in English between January 1, 2008, and February 1, 2019. Titles and abstracts of the studies were screened. Two reviewers independently appraised the full text of selected studies and extracted data using standardized tools from JBI. Where possible, data were pooled in statistical meta-analysis. Effect sizes were expressed as standardized mean differences, and their 95% confidence intervals were calculated for analysis. A total of 14 studies were included in the systematic review. Sample sizes of the included studies ranged from 14 to 392 participants. Of the included studies, four were randomized controlled trials and 10 were quasi-experimental studies. The overall quality of the included studies was compromised due to lack of true randomization, concealment, blinding, or the use of a single-group without a comparator. Educational-style interventions were investigated in six included studies and mindfulness-based interventions in four studies. The remaining four studies investigated organizational-directed interventions that incorporated a variety of strategies. The top three most commonly used tools were the Maslach Burnout Inventory, the Perceived Stress Scale, and the Professional Quality of Life Scale. The studies that investigated educational interventions reported a statistically significant reduction in both stress and/or burnout. Three of the four studies that investigated mindfulness-based interventions reported reduced stress levels. A fixed-effects meta-analysis of two of the studies demonstrated a non-significant difference in stress between groups receiving mindfulness-based interventions and those who did not (n = 58, SMD = -0.32, 95% CI -0.84 to 0.20, P = 0.23; heterogeneity: x = 0.01, P = 0.93, I = 0%). Organizational-based interventions were found to reduce stress levels but increase burnout. Individual-focused interventions, including both educational interventions and mindfulness-based interventions, have the potential to reduce occupational stress and/or burnout for staff working in emergency departments. However, inconsistencies in reporting and outcome measurements impact certainty of results. More high-quality randomized controlled trials are recommended with larger sample sizes as well as measurement of long-term effects to improve knowledge in this field.

Diabetes at the front door. A guideline for dealing with glucose related emergencies at the time of acute hospital admission from the Joint British Diabetes Society (JBDS) for Inpatient Care Group.

People with diabetes account for nearly one-fifth of all inpatients in English and Welsh hospitals; of these, up to 90% are admitted as an emergency. Most are admitted for a reason other than diabetes with only 8% requiring admission for a diabetes-specific cause. Healthcare professionals working in emergency departments experience numerous clinical challenges, notwithstanding the need to know whether each individual with diabetes requires urgent admission. This document has been developed and written by experts in the field, and reviewed by the parent organizations of the Joint British Diabetes Societies for Inpatient Care-Diabetes UK, the Diabetes Inpatient Specialist Nurse Group and the Association of British Clinical Diabetologists. The document aims to support staff working in emergency departments and elsewhere by offering practical advice and tools for effective, appropriate and safe triage. Each section relates to the commonest diabetic specific emergencies and algorithms can be printed off to enable ease of access and use.

Development of a coping model for work‐related fear among staff working in emergency department in Finland – study for nursing and medical staff

The emergency department is a workplace where the staff regularly encounter new challenges and factors that can cause fear. The aim of this study was to describe coping with work-related fear among emergency department staff. The study explains the current coping methods of emergency department staff and the requirement for support as well as the availability of support. A coping model for work-related fear was also developed and will be presented. The study was conducted using a survey developed specifically for this study, which included the Brief COPE Inventory. The study was conducted in 16 hospitals (N=544) among the doctors, nurses, practical nurses, and orderlies of the emergency departments. The results were analysed using statistical methods such as frequencies, cross-tabulation, principal component analysis and binary logistic regression analysis. All values of p<0.05 were considered statistically significant. The results showed that nearly all of the emergency department personnel had experienced work-related fear. Most of the respondents to the survey would have wanted more support, professional help, preventive action and more resources for the emergency department. The emergency department staff had used several coping methods to cope with fear. The most commonly used coping methods were problem-focused coping and social support. Based on the results of the study, it is possible to increase the availability of coping methods and further develop the existing coping methods.

Work Place Violence Against Nursing Staff Working in Emergency Departments at General Hospitals in Basra City

This study including 84 nurses working at emergency departments at general hospitals in Basra City, to determine the rate and sources of different types of violence, some characteristics of violence incidents and reactions of nurses towards violence incidents. Results showed the majority were exposed to work place violence (90.5%). Exposure to work place violence rate among males (93.8%) was higher than among females (86.1%). Exposure to work place violence rate was lower among younger than 30years of age (77.8%) than older participating. The majority (71.1%) of the participants were exposed to verbal violence. Relatives of the patients were the major source of violence (86.8%), the main time of exposure to violence was during night shift (48.7%). The main reason for not submitting the incident of violence reports was that they consider it of no importance (76.3%). Nothing was done was consequence for (35.3%) of the work place violence. The main single feeling was disappointment which was expressed by (32.8%) of the participants who exposed to violence.

Understanding management and support for domestic violence and abuse within emergency departments: A systematic literature review from 2000-2015.

To identify, review and critically evaluate published empirical studies concerned with the prevalence, management and support for survivors of domestic violence and abuse who present at emergency department. Domestic violence and abuse is a global phenomenon with a wealth of studies that explore the different aspects of the issue including the economic, social and health effects on survivors and on society as a whole. Emergency department is widely recognised as one healthcare facility where domestic violence and abuse survivors will often disclose domestic violence and abuse. In the UK, National Institute of Clinical Excellence produced guidelines in 2014 requiring all sectors of health care and those they work alongside to recognise support and manage survivors of domestic violence and abuse. Whilst there is an increasing body of research on domestic violence and abuse, limited synthesised work has been conducted in the context of domestic violence and abuse within emergency department. This review encompasses empirical studies conducted in emergency department for screening interventions, management and support for domestic violence and abuse patients including prevalence. This review included studies that included emergency department staff, emergency department service users and domestic violence and abuse survivors. A systematic approach across five electronic bibliographic databases found 35 studies meeting the inclusion criteria published between 2000-2015. From the 35 studies, four descriptive overarching themes were identified (i) prevalence of domestic violence and abuse in emergency department, (ii) use of domestic violence and abuse screening tools and emergency department interventions, (iii) current obstacles for staff working in emergency department and (iv) emergency department users and survivor perspectives. Having knowledgeable and supportive emergency department staff can have a positive benefit for the longer-term health of the domestic violence and abuse survivor who seeks help. The physical characteristics of domestic violence and abuse are often easier to identify and manage, but emotional and psychological aspects of domestic violence and abuse are often more complex and difficult for staff to identify. This therefore raises questions as to what approaches can be used, within these busy settings, when often survivors do not want to disclose. Domestic violence and abuse has been shown to have a direct impact on the health and well-being of survivors who will often access emergency department services with direct injuries and associated medical conditions. This article is relevant to those working in the emergency department in raising awareness in a number of areas of practice for example the prevalence of male intimate partner violence survivors. Furthermore, patients do not always disclose domestic violence and abuse even in cases where there is clear sustained injury thus requiring staff to be vigilant to repeat attendees and patient history. This requires a well-maintained and effective reporting system for instances of suspected and disclosed domestic violence and abuse in order that staff can provide the appropriate care and support. Emergency department staff often deal with complex cases, this includes different aspects of domestic violence and abuse including physical, emotional and psychological abuse. Continual support and guidance, including educational interventions, would assist emergency department clinical staff to manage and discuss instances of domestic violence and abuse in their workplace and their interactions with domestic violence and abuse patients. Whilst training for emergency department staff is welcomed, there also needs to be a greater awareness of the potential complexity of domestic violence and abuse presentations beyond physical injury in order for staff to remain observant throughout consultations. It is also suggested that clear domestic violence and abuse assessment and referral mechanisms should be embedded into clinical practice, including emergency department, as described in the UK National Institute of Clinical Excellence guidelines (2014). Overall improvements in reporting mechanisms in emergency department for the identification, management and support for domestic violence and abuse survivors would add to the collective and growing body of evidence surrounding domestic violence and abuse and their presentations within healthcare settings. Such measures would enable those working in emergency department to support disclosure of domestic violence and abuse more effectively.

Breaking down the barriers to mental health crisis care: Evaluation of a training package for emergency department clinicians

IntroductionAbout one in 20 attendances at emergency departments (EDs) in the UK relate to mental health, yet recent work has shown that a majority of people presenting with mental health crises do not report positive experiences (Care Quality Commission, 2015). Although there are many reasons for this, one may be a lack of mental health training for staff working in EDs. In response to this, a new training module for multi-professional ED staff was developed.Objectives and methodsWe aimed to assess the impact of this new module on clinicians’ confidence in managing mental health presentations. Thirty-eight ED doctors and nurses across two centers were asked to complete surveys before and after receiving training.ResultsFollowing training, we found improvements in confidence in each of five domains explored: assessing self-harm; managing someone with personality difficulties; assessing psychotic symptoms; distinguishing between physical and psychotic symptoms; and, managing psychotic symptoms. These improvements were seen for clinicians across both centers.ConclusionsThe results show that training can help to improve confidence around mental health. This is particularly important given that before the training was developed a survey of local ED doctors had shown that 31% felt under-confident in managing mental health conditions. Since developing the training, it has been further enhanced at the request of local EDs to include video-based scenarios. We continue to assess its impact in improving the confidence of ED clinicians (as well as their knowledge, skills and attitudes towards mental health), and ultimately the benefit to patients experiencing mental health crises.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Are adults in need of support and protection being identified in emergency departments?

Purpose – Frequent attendance at emergency departments (ED) has been identified in adult protection reviews as a potential warning sign of the escalation of someone’s vulnerability. Concern has been expressed about the engagement of the National Health Service (NHS) in adult protection and the small number of NHS adult protection referrals. More specifically ED departments have been identified as an area of high patient through put where there has been little evidence around how well adult support and protection (ASP) was being delivered. The paper aims to discuss these issues. Design/methodology/approach – A series of audits were undertaken in three different hospitals across a large Scottish Health Board accessing ED at different times of day on different days of the week to test out whether NHS staff working in EDs are identifying adults who meet the criteria of “an adult at risk”. Findings – The audits identified a total of 11 patients from a total sample of 552 records examined who may have met the criteria to be considered an adult at risk, although further information would have been required to make a fully informed decision. Research limitations/implications – The main study limitation is that the hospitals are all within a single Health Board. The EDs have a large number of admissions and it is possible that a less pressurised area, might have a lower threshold of “risk” than the practitioners involved in the audits. The decision as to whether an adult was considered to meet the three-point test by the three people undertaking the audit was dependent on the quality of information recorded on the patients’ electronic hospital record. Practical implications – It is essential that NHS Boards proactively support practice in ED settings so staff are able to identify adults at risk of harm under the ASP legislation so that ED staff are responsive to ASP needs. Originality/value – The research evidence around adult protection in the UK is still emerging. The development of good practice based on the Scottish Government’s ASP legislation is still being shaped. In England and Wales, the principles of identification and multi-agency working underpinning the safeguarding of vulnerable individuals are broadly similar to Scotland. These audits add to the literature by challenging the assumption that patients who would benefit from local authority investigation and possible support are not being identified within EDs.

Patient-related violence against nursing staff working in emergency departments: a systematic review

Review Questions/Objectives The objective of this systematic review is to synthesise the best available evidence on the impact of patient-related violence against nurses working in the Emergency Department. Review question How does patient-related workplace violence impact on emergency nurses? Types of participants The review will consider studies that include nurses working in Emergency Departments. Phenomena of interest The phenomenon of interest is patient-related violence, including two key sub-groups young adults (16-25 years) and parents/carers of paediatric patients. Types of outcome Outcomes considered will include: - - Frequency of episodes of violence; - The types of violence - physical and verbal; - Organisational reporting of episodes of violence; - Antecedents and risk factors; - Impact and sequelae of violence: psychological and physical effects; - Prevention and control measures to manage episodes of violence.

Ideal care and the realities of practice: interdisciplinary relationships in the management of advanced cancer patients in Australian emergency departments

Over the course of their illness, a person with cancer is likely to see a number of different healthcare professionals, including those in the emergency department (ED). There is limited research examining the interaction and communication between the involved healthcare professionals when such a patient presents to the ED. This study aimed to explore the views and experiences of interdisciplinary interactions of healthcare professionals caring for patients with advanced cancer who present to the ED. Focus groups and semistructured interviews were conducted with clinical staff working in ED, oncology and community and hospital-based palliative care services. Interviews and focus groups were recorded and transcribed verbatim. Thematic analysis was undertaken by three researchers independently. These themes were then discussed by the wider team and consensus reached on themes and subthemes. Eighty-three healthcare professionals participated in focus groups, and 11 were interviewed. The over-arching theme to emerge was one of a conflict between ideal care and the realities of practice, particularly arising where clinicians from different services were required to work together to provide care. This idea was further understood through a series of subthemes including communication, decision-making and understanding of other services. Participants articulated agreed upon ideals of optimal care for advanced cancer patients across all three services, however there was frequently discord between these ideals and the actual care provided. Service demands and the day-to-day stressors of practice appeared to influence people's actions and engender conflict.

Iraqi community members' knowledge, attitude and practice of emergency medical care: assessing civilian emergency medicine in an area of conflict

The objective of this article is to assess community member knowledge, attitude, and practice of emergency medical care in Baghdad, Iraq. We performed a randomized, cluster-based, household Knowledge, Attitude, and Practice (KAP) survey regarding pre-hospital and hospital-based emergency medical care among Baghdad community members. A total of 1172 individuals participated in the survey. While most (93.5%) understood that for a serious injury, one should go to the hospital within three hours, only half (50.6%) felt that ambulances were beneficial and only 5% knew that there was a number to call in case of medical emergency. Regarding attitudes, only half (50.2%) of those interviewed felt an ambulance would arrive within an hour, while higher proportions of people believed that paramedics (59.1%) and medical staff working in emergency departments were adequately trained (71.5%). In terms of practice, most Iraqis responded that they would seek care in a hospital (84.8–90.0%) by means other than an ambulance (98.0–99.2%). However, if an ambulance arrived, 77% would allow it to transport their friends/family and 73.5% would trust the medical staff in the hospital to appropriately treat them. Our conclusion is that emergency medical care in Iraq is still in the development phase. Although numerous ambulances have been commissioned, scores of paramedics have been trained, and staff working in Baghdad Emergency Departments have undergone updates in their practice, the public does not appear to be fully informed of these changes. Future developments in Iraqi emergency medical care should include targeted efforts to expand the public awareness of such services.

Airbag-related chest wall burn as a marker of underlying injury: a case report

IntroductionThis case of a man who sustained an airbag-induced thoracic injury and burn, highlights the potential harm that can be caused by airbags. It also serves to illustrate that a surface burn which looks small and benign can actually be a surface marker of a more serious injury. Staff working in emergency departments need to be aware of the risk of possible airbag-associated injuries.Case presentationA 65-year-old man was the driver in a frontal collision. He was wearing a seatbelt. The airbag was activated and caused a superficial chest wall burn. Initial chest x-rays were unremarkable but following deterioration in his condition, a computed tomography scan revealed a serious sternal fracture. The location of the fracture was marked on the surface by the burn.ConclusionAirbags can cause significant chest wall injuries and burns. Surface burns at the point of impact should not be dismissed as trivial as the forces involved can cause significant injury. We recommend that all people with chest wall injuries and/or burns due to airbags should have more detailed chest imaging as initial emergency radiographs can be falsely reassuring.

Incident monitoring

At the invitation of the Department of Health, Housing, Local Government and Community Services, the College sought funding for a study on Incident Monitoring in emergency departments. (The identification of potential and actual adverse events which are preventable.) The application was successful, with funding provided to allow for a pilot project incorporating a sample of representative hospitals (teaching, urban and rural). This approach which aims at identifying potential and actual adverse patient incidents had been utilised by the Faculty of Anaesthetists, Royal Australasian College of Surgeons (now Australian and New Zealand College of Anaesthetists) for a number of years with great success. The aim of such an exercise is not only to identify potential and actual incidents but also to identify causation and implement preventive strategies in order to prevent such incidents from occurring. The aims of the project are: The identification and categorisation of adverse patient incidents occurring in public hospital emergency departments in Australia. The development of an effective reporting/data collection system for adverse patient incidents. The facilitation of local quality assurance programs utilising the data collected in the proposal. The development of an ongoing data collection/reporting system leading to the integration of data, both statewide and nationally, in order to identify common problems and trends. The development of proposals to overcome identified problems in order to reduce the incidence of adverse patient incidents. The identification of incidents which are currently reported eg. to coroners courts, complaints units, and those which result in litigation. The quantification of cost savings that can accrue as a result of a reduction in the number of adverse patient incidents. The distribution of the results of the study to all staff working in emergency departments in order to make them more aware of potential problems. Peculiar aspects of emergency departments which highlight the need for such a process include: Patient load is largely “undifferentiated” ie. many and every condition can present with many conditions having signs and symptoms which are similar. Pressure of time on staff to get the work done thus requiring rapid decision making and the “cutting of corners”. The length of contact time with patients is often short, resulting in an inability to monitor patient's progress and, just as importantly, to obtain all the results of all investigations prior to making a more informed decision. The necessity to attend to a number of patients at the same time and to stop what you are doing to attend to something more urgent. Constant activity with little or no time to sit down and think. Staffing largely consisting of junior medical staff, often without adequate supervision. Because of the very nature of the emergency department environment, both potential and actual adverse incidents are thought to be common, thus placing both patient and staff at risk; patients, because of the impact of the incident, and staff because of medico legal ramifications. Without hard data it is very difficult to convince administrators who hold the purse strings to release funds to improve patient care. Documentation of adverse incidents both potential and actual over a period of time, and the involvement of a range of hospitals, will be expected to identify those areas which need attention. Preliminary analysis of results confirms that there are a small but nevertheless very important number of factors contributing to adverse incidents. First on the list is junior unsupervised medical staff on duty after hours. It can therefore be seen that appropriate documentation and analysis of both potential and adverse incidents can assist emergency department managers to seek funds to improve patient care. The concept of incident monitoring leads on to the concept of “risk management” which is in essence the identification of high risk patients/situations and the introduction of preventive strategies in order to reduce the likelihood of an adverse incident. With increasing pressure from both the public and hospitals for an improved standard of care in emergency departments, coupled with the increasingly active legal environment it is becoming more and more important to incorporate risk management into day to day department activities. Particular emphasis should be placed on those areas identified (by such exercises as incident monitoring) as potentially high risk situations. Incident monitoring in one form or another is here to stay, this is also true of risk management and department managers should be encouraged to educate themselves and their staff in relation to the value of incident monitoring and risk management so as to ensure an appropriate standard of care and reduction in legal risk. The final report of the Incident Monitoring Project will be available later this year with a detailed presentation of the study's findings to be presented at a seminar to be held in November.