Crowding, Staffing Shortages Imperil Safety in Hospital Emergency Departments

Newswise — Hospital emergency departments are not as safely designed and managed as they should be and improvements in working conditions are needed, according to a study published online in the December 2008 issue of The Annals of Emergency Medicine.

The study, which was funded by the Agency for Healthcare Research and Quality, is the first to examine closely safety from the perspective of emergency department doctors and nurses.

Researchers surveyed 3,562 emergency medicine clinicians in 65 hospitals to examine their perceptions about their emergency department's safety. At all of the hospitals surveyed, respondents reported problems with the safety of emergency care systems. For example, the majority of respondents said that emergency departments consistently lack sufficient space to deliver patient care.

The study also found that:

"¢ Nearly two-thirds of emergency department clinicians reported that they have insufficient space to deliver patient care. "¢ One third indicated the number of patients consistently exceeds their emergency department's capacity to provide safe care. "¢ Forty percent reported physician staffing is insufficient to handle patient loads during busy periods. "¢ Two-thirds reported nursing staff is insufficient to handle patient loads during busy periods. "¢ Only a third of respondents reported that patients in their emergency department's waiting rooms are monitored often.

The study was conducted by a team of researchers with the Kaiser Permanente Colorado Institute for Health Research, the University of Colorado Health Science Center; Massachusetts General Hospital, Harvard Medical School, Yale School of Public Health, Yale School of Medicine; Weill Medical College of Cornell University and New York-Presbyterian Hospital.

The researchers recommend the following improvements.

"¢ Increase or redesign emergency department space. "¢ Increase staffing during periods of high demand. "¢ Improve information sharing between clinicians by reworking team processes. "¢ Improve transitions of patients between the emergency department and inpatient areas of the hospital . "¢ Provide more computer workstations and easy access to electronic health records.

"This is a national problem," said lead author David Magid, M.D., senior scientist at the Kaiser Permanente Colorado Institute for Health Research and director for research at the Colorado Permanente Medical Group. "It doesn't matter if the hospital is big or small, an academic or community-based institution, or the region of the country," Dr.Magid added.

For details, see "The Safety of Emergency Care Systems: Results of a National Survey of Clinicians in 65 U.S. Emergency Departments," in the December 5, 2008 issue of Annals of Emergency Medicine.