748 SECUre -a multicenter survey of the safety of emergency care in UK emergency departments
Authors: Flowerdew Lynsey , Tipping Michelle 
Published: June 2022

Aims/Objectives/Background

According to safety theory, frontline staff are often best informed to identify problems that threaten safety in their workplace. Surveying emergency department (ED) staff is a straightforward method to assess safety culture including investigating risks, identifying solutions and evaluating interventions. This study‘s aim was to validate an ED safety questionnaire specifically for use in the UK and provide an overview of safety culture and risks. Differences between doctors and nurses’ perception of safety were also analysed.

Methods/Design

According to safety theory, frontline staff are often best informed to identify problems that threaten safety in their workplace. Surveying emergency department (ED) staff is a straightforward method for investigating risks, identifying solutions and evaluating interventions. Safety culture has been the focus of a succession of high-profile reports, including the Francis Report. This study‘s aim was to validate an ED safety questionnaire specifically for use in the UK and provide an overview of safety culture and risks. Differences between doctors and nurses’ perception of safety were also analysed.

Using groupings similar to the US safety questionnaire, Cronbach’s Alpha was calculated across five categories as an estimate of reliability. Simple descriptive statistics were used to identify risks or good practice. Chi Square test compared individual sites’ results with national results to highlight outlier questions (i.e. the department’s strengths and weaknesses). Chi Square was also used to identify significant differences between responses from nurses and doctors.

Abstract 748 Table 1CategoryItem statementOverall respenses to Questions (%)Respenses to Questions (%)Sig. differenceDoctors/Nurses(p<0.05)Never/RarelySometimesUsually/AlwaysNever/RarelySometimesUsually/AlwaysTeamwork (Cronbach’s alpha = 0.65)Interruptions disrupt the ability of staff to provide care540558/345/3747/60*Doctors and nurses work well together in the ED05940/04/696/94Nurses feel empowered to question instructions from doctors when necessary215841/310/1689/81*Important clinical information is lost in handovers between doctors at the change of shift4845654/4542/485/7*There is good communication of patient management between ED doctors and nurses113861/16/1893/81*Important clinical information is lost in handovers between nurses at the change of shift4450645/4350/505/7Safety Leadership (Cronbach’s alpha = 0.78)There is an open, non-judgemental environment for reporting safety concerns622714/814/2882/64*In providing clinical care, patient safety is a top priority in the ED213851/310/1489/82*New nurses are well mentored by nurses with more experience924672/1417/2881/58*ED leadership takes action to improve safety of clinical care for patients in the ED321761/412/2787/68*Protocols are used for high risk or complex medication administration (e.g. sedation, thrombolytic therapy, blood transfusion)15941/15/594/94Junior doctors are adequately supervised in the ED416801/67/2392/72*Incident reporting is used to improve patient safety622724/724/2272/71Physical Environment & Equipment (Cronbach’s alpha = 0.80)It is easy to find the doctor/clinician caring for a patient525702/715/3283/62*Mental health patients are cared for in a safe environment25334214/3333/3353/34*Functioning routine physical examination equipment (e.g. ophthalmoscopes, lights for a gynaecologic examination, manual blood pressure cuffs) is available1124657/1423/2570/61*Monitoring devices (e.g. pulse oximeters, vital sign monitors, cardiac monitors) function in the ED715790/114/2295/67*There is sufficient space in the ED for the delivery of care36323229/4132/3238/28*ED personnel feel physically safe while working in the ED619741/109/3690/64*It is easy to find the nurse caring for a specific patient631638/535/2857/67*Staff & External Team (Cronbach’s alpha = 0.76)Appropriately experienced staff carry out triage/assessment417803/415/1882/78Clinician staffing is sufficient to handle the patient care load during busy periods30393123/3538/3939/26*Nurse staffing is sufficient to handle the patient care load during busy periods43332436/4735/3329/20*Stat medications are administered in a timely manner632636/636/2958/65CT (computed tomography) scans are completed within 1 hour when clinically indicated632625/730/3365/60The number of patients cared for exceeds the capacity of the ED to provide safe care8425011/646/3842/56*Monitoring of vital signs/Early Warning Scores are used effectively in the ED214841/313/1486/83Initial assessment/triage works well in my department320772/419/2179/75The critical care team provide support in a timely manner212861/210/1490/84*Patients receive timely access to mental health care28393220/3537/4144/25*Organisatisational Factors & Informatics (Cronbach’s alpha = 0.73)ED staff feel unduly pressurised by hospital managers to prioritise targets over patient care10424817/647/3835/56*Patients are transferred to an in-patient bed in a timely manner30363430/2935/3634/34Hospital escalation procedures are effective at improving flow in the ED28363633/2533/3834/37*Hospital managers support improvements in patient safety in the ED15404411/1840/4149/41*Procedures to report errors and near misses are user-friendly16216318/1526/1856/68*Effective systems are in place to highlight patient alerts (e.g. allergies, dementia) to ED staff618764/718/1878/75It is difficult to obtain a patient’s primary care records when needed20443622/2032/5246/28*It is difficult to gain access to a patient’s hospital medical record when needed54341261/5028/3822/12*There are an adequate number of functioning computers in the ED20215821/2023/2156/59Abstract 748 Figure 1Abstract 748 Figure 2

Results/Conclusions

1060 participants were recruited across 18 sites (see attachments). Analysis highlighted risks posed by interruptions, negative effects of targets, deficient mental health care (especially compared to critical care) and ED crowding. Identifying outlier sites provided opportunities to learn from excellence. Comparing doctors and nurses’ responses highlights additional support is needed for nursing staff. This study provides the first step towards assessing ED safety culture and describing risks in the UK.