Emergency Physicians' Top Safety Concerns Are Crowding and Shortages Of On-Call Specialists and Nurses
A new poll of emergency physicians reveals a gap between national safety benchmarking programs and actual safety concerns among emergency physicians, with crowding from inpatient boarding deemed the greatest threat to patient safety overall.
Washington, DC— A new poll of emergency physicians reveals a gap between national safety benchmarking programs and actual safety concerns among emergency physicians, with crowding from inpatient boarding deemed the greatest threat to patient safety overall. The survey results are published online today in the Annals of Emergency Medicine (“Emergency Physician Perceptions of Patient Safety Risks”).
“None of the top three safety concerns that emergency physicians have are measured or rewarded by governmental and quality organizations, which suggests that we need to re-align national goals with what is actually happening in our nation’s ERs,” said lead study author David Sklar, MD, FACEP of the University of New Mexico Department of Emergency Medicine in Albuquerque. “While safety concerns differ between urban/suburban emergency physicians and rural emergency physicians, all emergency physicians ranked the shortage of on-call specialists either first or second on their list of safety concerns. This is very disturbing, especially if you are the patient waiting for help from a neurologist or hand surgeon or some other specialist.”
Researchers polled 2,507 emergency physicians, 44 percent practicing in urban emergency departments, 42 percent in suburban emergency departments and 13 percent in rural emergency departments. Respondents were asked to rank 16 patient safety factors, which were drawn from the medical literature and Centers for Medicare and Medicaid Services (CMS) and The Joint Commission (TJC) standards. Crowding from inpatient boarding ranked first among urban and suburban respondents and seventh among rural respondents. The lack of availability of on-call specialists ranked second for urban and suburban respondents and first for rural respondents. All three groups ranked the shortage of nurses third most important patient safety factor.
Patient safety measures that have been adopted by TJC, CMS and the National Quality Forum generally fell much lower on the priority list for respondents. One example, the measure requiring that antibiotics be administered within four hours for patients with pneumonia, was listed 11th for rural respondents, 12th for suburban respondents and 14th for urban respondents.
“Emergency medicine safety concerns among the physicians who actually treat patients are not being adequately addressed by the national bodies charged with safety in emergency departments,” said Dr. Sklar. “This is quite surprising because the emergency department is recognized as a high risk area for patient care. Efforts to address patient safety should concentrate on those areas that most concern the practicing emergency physicians who see first-hand the dangers of crowding and staff shortages.”
Annals of Emergency Medicine is the peer-reviewed scientific journal for the American College of Emergency Physicians, a national medical society with more than 28,000 members. ACEP is committed to advancing emergency care through continuing education, research, and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies. For more information visit www.acep.org.
