The perception of the patient safety climate by professionals of the Emergency Department

Rigobello, M.C.G. et al. International Journal of Emergency Nursing | Published online 13 March 2017

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Highlights:

  • Critical and emergency care units are challenging and stressful environments.
  • Measuring safety climate assists in assessing safety culture.
  • Study participants’ perceptions were considered to be negative.
  • The majority of study participants demonstrated job satisfaction.
  • Low scores for participants’ perceptions of management may indicate fear of reprisals.

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What do emergency physicians in charge do? A qualitative observational study

Hosking, I. et al. Emerg Med J Published Online First: 10 March 2017

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Introduction: The emergency physician in charge role has developed in many large EDs to assist with patient flow. We aimed to describe and classify the problem-solving actions that this role requires.

 

Conclusions: Emergency physicians in charge have a number of problem-solving approaches that can be readily defined. We have described and categorised these. These results are potentially useful for developing decision support software.

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Packaging Patients and Handing Them Over

Nugus, P. et al. Annals of Emergency Medicine. Published online: December 11 2016

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Study objective: Communication is commonly understood by health professional researchers to consist of relatively isolated exchanges of information. The social and organizational context is given limited credit. This article examines the significance of the environmental complexity of the emergency department (ED) in influencing communication strategies and makes the case for adopting a richer understanding of organizational communication.

 

Conclusion: This study shows that handoff of patients from the ED to other hospital departments is a complex communication process that involves more than a series of “checklistable” information exchanges. Clinicians must learn to use both negotiation and persuasion to achieve objectives.

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Impact of alcohol abuse on the emergency services

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The All-Party Parliamentary Group on Alcohol Harm has published The Frontline Battle.

This report presents the results of an inquiry into the impact of alcohol on emergency services. It sets out the extent of the pressures and dangers of alcohol related problems placed on the emergency services and discusses the impact on staff, the impact on service provision and the effect on time and resources.

Workplace aggression as cause and effect

Wolf, L.A. et al. International Emergency Nursing. Published online: November 9, 2016

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  • Fatigue compromises nurses’ personal lives and creates a toxic unit environment.
  • Fatigue compromises safe patient care.
  • Below-adequate staffing levels are a major source of fatigue.
  • Lateral violence (workplace bullying) is both a cause and effect of fatigue.

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Active Intervention Can Decrease Burnout In Ed Nurses

Wei, R. et al. Journal of Emergency Nursing. Published online: September 16 2016

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Introduction: The aim of this study was to evaluate whether active intervention can decrease job burnout and improve performance among ED nurses.

Methods: This study was carried out in the emergency departments of 3 hospitals randomly selected from 8 comprehensive high-level hospitals in Jinan, China. A total of 102 nurses were enrolled and randomly divided into control and intervention groups. For 6 months, nurses in intervention groups were treated with ordinary treatment plus comprehensive management, whereas nurses in the control group were treated with ordinary management, respectively. Questionnaires were sent and collected at baseline and at the end of the study. The Student t test was used to evaluate the effect of comprehensive management in decreasing burnout.

Results: All ED nurses showed symptoms of job burnout at different levels. Our data indicated that comprehensive management significantly decreased emotional exhaustion and depersonalization (P < .01).

Discussion: The findings suggest that active intervention with comprehensive management may effectively reduce job burnout in ED nurses and contribute to relieving work-related stress and may further protect against potential mental health problems.

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Emergency Manual Uses During Actual Critical Events and Changes in Safety Culture From the Perspective of Anesthesia Residents: A Pilot Study

Goldhaber-Fiebert, S. et al. Anesthesia & Analgesia. 123(3) pp. 641–649

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Background: Emergency manuals (EMs), context-relevant sets of cognitive aids or crisis checklists, have been used in high-hazard industries for decades, although this is a nascent field in health care. In the fall of 2012, Stanford clinically implemented EMs, including hanging physical copies in all Stanford operating rooms (ORs) and training OR clinicians on the use of, and rationale for, EMs. Although simulation studies have shown the effectiveness of EMs and similar tools when used by OR teams during crises, there are little data on clinical implementations and uses. In a subset of clinical users (ie, anesthesia residents), the objectives of this pilot study were to (1) assess perspectives on local OR safety culture regarding cognitive aid use before and after a systematic clinical implementation of EMs, although in the context of long-standing resident simulation trainings; and (2) to describe early clinical uses of EMs during critical events.

Methods: Surveys collecting both quantitative and qualitative data were used to assess clinical adoption of EMs in the OR. A pre-implementation survey was e-mailed to Stanford anesthesia residents in mid-2011, followed by a post-implementation survey to a new cohort of residents in early 2014. The post-implementation survey included pre-implementation survey questions for exploratory comparison and additional questions for mixed-methods descriptive analyses regarding EM implementation, training, and clinical use during critical events since implementation.

Results: Response rates were similar for the pre- and post-implementation surveys, 52% and 57%, respectively. Comparing post- versus pre-implementation surveys in this pilot study, more residents: agreed or strongly agreed “the culture in the ORs where I work supports consulting a cognitive aid when appropriate” (73.8%, n = 31 vs 52.9%, n = 18, P = .0017) and chose more types of anesthesia professionals that “should use cognitive aids in some way,” including fully trained anesthesiologists (z = −2.151, P = .0315). Fifteen months after clinical implementation of EMs, 19 respondents (45%) had used an EM during an actual critical event and 15 (78.9% of these) agreed or strongly agreed “the EM helped the team deliver better care to the patient” during that event, with the rest neutral. We present qualitative data for 16 of the 19 EM clinical use reports from free-text responses within the following domains: (1) triggering EM use, (2) reader role, (3) diagnosis and treatment, (4) patient care impact, and (5) barriers to EM use.

Conclusions: Since Stanford’s clinical implementation of EMs in 2012, many residents’ self-report successful use of EMs during clinical critical events. Although these reports all come from a pilot study at a single institution, they serve as an early proof of concept for feasibility of clinical EM implementation and use. Larger, mixed-methods studies will be needed to better understand emerging facilitators and barriers and to determine generalizability.

Read the abstract here