Interruptions, targets, overcrowding and deficient mental health care are the main risks to patient safety in the emergency department (ED), finds a national survey of ED doctors and nurses in 18 EDs across the UK.
The survey used a US-developed safety questionnaire which was adapted to the UK setting and validated using 33 Royal College of Emergency Medicine patient safety leads. The resulting 39 multiple-choice questionnaire was completed by 1060 ED doctors and nurses from 18 Level 1 EDs.
The findings, published in the Emergency Medicine Journal, show high levels of satisfaction with the working relationship between ED doctors and nurses, and almost all departments used protocols for high-risk or complex medication administration.
However, the results also highlight the risks posed by interruptions, the negative effects of targets, deficient mental health care and ED crowding.
More than a third (36%) of participants said there is never or rarely sufficient space in the ED to deliver care. Thirty per cent said clinician staffing levels are never or rarely sufficient to handle patient care load during busy periods. Half said the number of patients cared for usually or always exceeds the capacity of the ED to provide safe care.
Thirty per cent said patients were never or rarely transferred to an inpatient bed in a timely manner, and 28 per cent said hospital escalation procedures were never or rarely effective in improving patient flow.
While 82 per cent said the critical care team usually or always provides support in a timely manner, this fell to 32 per cent for mental health care, with 28 per cent of respondents saying patients rarely or never receive timely access to mental health care.
Almost half (48%) said ED staff feel unduly pressured by hospital managers to prioritise targets over patient care, and 15 per cent said hospital managers rarely or never support improvements in patient safety.