Violence against nurses working in the emergency department

Workplace violence (WPV) in healthcare organizations can lead to serious consequences that negatively affect nurses’ lives and patient care | International Emergency Nursing

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Highlights:

  • Nurses who experience WPV complain of mental and physical health problems.
  • Nurses’ social and professional lives were affected negatively after facing WPV.
  • WPV consequences negatively impact nurses and the entire healthcare organization.
  • The serious consequences of WPV ultimately harm patient care.
  • Preventing violence will ensure a safe workplace and safer patient care.

Full reference: Hassankhani, H. et al. (2017) The consequences of violence against nurses working in the emergency department: A qualitative study. International Emergency Nursing. Published online: 31 July 2017

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Sepsis care in UK Emergency Departments is improving

Sepsis care is improving but treatment needs to be faster, according to a new audit by the Royal College of Emergency Medicine.

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Image source: http://www.rcem.ac.uk

The report published this month audited 13,129 adults presenting to 196 Emergency Departments (EDs), and was endorsed by the Sepsis Trust.  It shows an improvement in the proportion of patients receiving the best care for severe sepsis and septic shock, but that improvements are needed to make treatment available faster.

The audit is designed to drive clinical practice forward by helping clinicians examine the work they do day-to-day and benchmark against their peers, and to recognise excellence.  There is much good practice occurring and RCEM believes that this audit is an important component in sharing this and ensuring patient safety.

The report finds that there has been a steady improvement in the ‘Sepsis-Six’, an initial resuscitation bundle designed to offer basic interventions within the first hour of arriving at an ED. However, despite seeing improvements in care, the report finds that RCEM standards are not yet being met by all EDs.

Full report:  Severe Sepsis and Septic Shock. Clinical Audit 2016/17

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.

Read the full abstract here

Only a third of MPs believe that A&E departments are adequately resourced 

Parliamentary perceptions of A&E departments |  A poll of UK MPs by Dods Research on behalf of the Royal College of Emergency Medicine

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A poll on behalf of  the Royal College of Emergency Medicine reveals just 33% of MPs believe emergency departments have the resources they need to keep patients safe.

The poll of 92 MPs of all parties and regions of the UK also found strong support for a transformation fund for emergency departments with four times as many saying they would support such an initiative as oppose it.

Over 60% of MPs said they would support Emergency Departments (EDs) receiving more money to help with the retention and recruitment of staff.

Despite government claims that the NHS was getting more than the minimum £8bn by 2020 it had asked for, the poll found that only half of Conservative MPs believe that Emergency Departments are currently being adequately resourced.

View the full report here

Nurses’ Perceptions of Factors Involved in Safe Staffing Levels in Emergency Departments

Wolf, L. A. et al. Journal of Emergency Nursing. Published online: November 8 2016

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Introduction: The emergency department is a unique practice environment in that the Emergency Medical Treatment and Active Labor Act (EMTALA), which mandates a medical screening examination for all presenting patients, effectively precludes any sort of patient volume control; staffing needs are therefore fluid and unpredictable. The purpose of this study is to explore emergency nurses’ perceptions of factors involved in safe staffing levels and to identify factors that negatively and positively influence staffing levels and might lend themselves to more effective interventions and evaluations.

Methods: We used a qualitative exploratory design with focus group data from a sample of 26 emergency nurses. Themes were identified using a constructivist perspective and an inductive approach to content analysis.

Results: Five themes were identified: (1) unsafe environment of care, (2) components of safety, (3) patient outcomes: risky care, (4) nursing outcomes: leaving the profession, and (5) possible solutions. Participants reported that staffing levels are determined by the number of beds in the department (as in inpatient units) but not by patient acuity or the number of patients waiting for treatment. Participants identified both absolute numbers of staff, as well as experience mix, as components of safe staffing. Inability to predict the acuity of patients waiting to be seen was a major component of nurses’ perceptions of unsafe staffing.

Discussion: Emergency nurses perceive staffing to be inadequate, and therefore unsafe, because of the potential for poor patient outcomes, including missed or delayed care, missed deterioration (failure to rescue), and additional ED visits resulting from ineffective discharge teaching. Both absolute numbers of staff, as well as skill and experience mix, should be considered to provide staffing levels that promote optimal patient and nurse outcomes.

Read the abstract here

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

High volume emergency surgery units do not improve outcomes, report finds

Gulland, A. BMJ. 2016. 353:i2054

The move to centralised services for emergency general surgery would not improve outcomes or reduce mortality rates, a report has found.1

The Nuffield Trust looked at the problems facing emergency general surgery and found that the “widely held perception that centralisation will drive up quality” did not hold true. It found that there was no clear relationship between the number of procedures performed and surgical outcomes.

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Image source: Nuffield Trust

The report, commissioned by the Royal College of Surgeons of England, found that there was little variation in mortality between sites that performed a large number of procedures and those that did not. The report looked at hospital episode statistics at 154 sites in England between 2009-10 and 2012-13 to compare mortality rates between those that performed a large number of procedures and those that did not.

It found that hospitals that performed around 50 or fewer major emergency surgical procedures annually had a mortality rate of just over 12%. Sites that performed more than 250 procedures a year had a mortality rate of just under 12%, and sites that performed 51 to 100 procedures annually had the lowest mortality rate of about 11%.

When researchers looked at very low volume sites—those performing less than 20 procedures annually—they found that there was no clear pattern of higher mortality.

View the full report here

View the full commentary here