Department of Critical Care, Emergency Medicine Unit, Ente Ospedaliero Cantonale, Lugano, Switzerland.
Finnish Patient Insurance Centre, Helsinki, Finland.
Eur J Emerg Med. 2023 Aug 1;30(4):280-286. doi: 10.1097/MEJ.0000000000001044. Epub 2023 May 24.
Patient safety in healthcare is one of the cornerstones of quality of care. The emergency department (ED) is by its very nature a place where errors and safety issues are liable to occur.
The aim of the study was to assess health professionals' perception of the level of safety in EDs and to identify in which work domains safety appears most at risk.
Between 30 January and 27 February 2023, a survey addressing the main domains of safety was distributed to ED health care professionals through the European Society of Emergency Medicine contact network. It addressed five main domains: teamwork, safety leadership, physical environment and equipment, staff/external teams, and organisational factors and informatics, with a number of items for each domain. Further questions about infection control and team morale were added. The Cronbach's alpha measure was calculated to assure internal consistency.
A score was developed for each domain by adding the question's value using the following ranking: never (1), rarely (2), sometimes (3), usually (4), and always (5) and was aggregated in three categories. The calculated sample size needed was 1000 respondents. The Wald method was used for analysis of the questions' consistency and X2 for the inferential analysis.
The survey included 1256 responses from 101 different countries; 70% of respondents were from Europe. The survey was completed by 1045 (84%) doctors and 199 (16%) nurses. It was noted that 568 professionals (45.2%) had less than 10 years' experience. Among respondents, 80.61% [95% confidence interval (CI) 78.42-82.8] reported that monitoring devices were available, and 74.7% (95% CI 72.28-77.11) reported that protocols for high-risk medication and for triage (66.19%) were available in their ED. The area of greatest concern was the disproportionate imbalance between needs and the availability of staff at times of greatest flow, considered sufficient by only 22.4% (95% CI 20.07-24.69) of doctors and 20.7% (95% CI 18.41-22.9) of nurses. Other critical issues were overcrowding due to boarding and a perceived lack of support from hospital management. Despite these difficult working conditions, 83% of the professionals said they were proud to work in the ED (95% CI 81.81-85.89).
This survey highlighted that most health professionals identify the ED as an environment with specific safety issues. The main factors appeared to be a shortage of personnel during busy periods, overcrowding due to boarding, and a perceived lack of support from hospital management.
医疗保健中的患者安全是护理质量的基石之一。急诊科（ED）的性质决定了它容易出现错误和安全问题。
本研究旨在评估卫生专业人员对 ED 安全性的感知，并确定在哪些工作领域安全性风险最高。
2023 年 1 月 30 日至 2 月 27 日，通过欧洲急诊医学学会的联系网络，向 ED 医疗保健专业人员分发了一份涉及安全主要领域的调查。它涉及五个主要领域：团队合作、安全领导力、物理环境和设备、员工/外部团队以及组织因素和信息学，每个领域都有多个项目。还增加了关于感染控制和团队士气的进一步问题。计算了克朗巴赫的 alpha 度量值以确保内部一致性。
为每个领域开发了一个分数，方法是使用以下排名添加问题的值：从不（1）、很少（2）、有时（3）、经常（4）和总是（5），并汇总为三个类别。计算所需的样本量为 1000 名受访者。使用 Wald 方法分析问题的一致性，使用 X2 进行推理分析。
该调查包括来自 101 个不同国家的 1256 名受访者；70%的受访者来自欧洲。调查由 1045 名（84%）医生和 199 名（16%）护士完成。注意到 568 名专业人员（45.2%）的经验不足 10 年。在受访者中，80.61%[95%置信区间（CI）78.42-82.8]报告说监测设备可用，74.7%（95%CI 72.28-77.11）报告说他们的 ED 有高危药物和分诊的协议（66.19%）可用。最令人关注的领域是在流量最大时，需求与员工可用性之间的不平衡不成比例，只有 22.4%（95%CI 20.07-24.69）的医生和 20.7%（95%CI 18.41-22.9）的护士认为这种不平衡是可以接受的。其他关键问题是由于住院而导致的过度拥挤和医院管理层的支持不足。尽管工作条件困难，83%的专业人员表示他们为在 ED 工作感到自豪（95%CI 81.81-85.89）。
这项调查强调，大多数卫生专业人员认为 ED 是一个存在特定安全问题的环境。主要因素似乎是高峰期人员短缺、住院导致的过度拥挤以及医院管理层的支持不足。
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