Emergency Departments and Hazardous Environments

The Annals of Emergency Medicine, June 2009, issue has an article that reports from an Emergency Department (ED) Safety Survey.

The Survey solicited perceptions of working conditions in the ED from more than 3,000 ED clinicians in 65 EDs.

"The results show that nearly two thirds of EDs do not consistently have sufficient space to deliver patient care , and one third consistently care for sick patients in hallways.

"In addition, more than a third of EDs do not have sufficient physician staffing to consistently handle patient loads during busy hours. Thus, not surprisingly, about one third of EDs consistently exceed their capacity to provide safe care for their patients.

"Important clinical information is consistently communicated from physician to physician and nurse to nurse at change of shift only about half the time. A quarter of our triage nurses are not well trained in emergency assessment. And, when patients are triaged back to the waiting room by these nurses, only a little more than a third are consistently monitored as often as necessary for their clinical condition.

"Almost a quarter of EDs do not consistently list patient safety as a top priority in providing clinical care, and a quarter of staff feel uncomfortable raising safety concerns with their supervisors. Finally, only about half report consistent support from hospital administration for safety improvements in the ED.

"These results suggest that our EDs are far from operating as high-reliability organizations; the number needed to harm for infrastructure failures here is around 10 compared with a number needed to harm for highly reliable organizations of around 1,000,000.

"However, high reliability organizations rely on the resilience of their staff for unexampled, extreme, or unforeseen events when established systems might be expected to falter; but EDs rely on the resilience of their staff for routine operations. Instead of the infrastructure supporting the clinicians, ED workers compensate for the infrastructure.

"We however pay a heavy price for depending on staff resilience to make up for system defects."