Patient safety

Essentials

• 1

  Approximately 1 in 10 hospital patients experiences an adverse event, of which half may be attributed to clinical error and one-third results in significant harm or death.

• 2

  Emergency medicine faces particular challenges to safe patient care due to the undifferentiated and potentially unstable patient case mix, high staff turnover, staff inexperience and fatigue and distractions, noise and overcrowding in the clinical care environment.

• 3

  Clinical errors in emergency medicine may include errors of patient identification, hospital-acquired infections due to poor procedure asepsis and patient isolation procedures, medication errors, misdiagnosis and failure of follow-up of investigation and imaging abnormalities, communication errors, physical care errors and mistriage.

• 4

  Improving patient safety in emergency departments (EDs) requires an understanding of the ED environment and a methodical stepwise approach to improving safety based upon:

  • a

    fostering reporting of clinical incidents, including ‘near misses’

  • b

    evaluating reported incidents using accepted methodologies such as root cause analysis

  • c

    treating the risk: this is rarely achieved by exhorting staff to ‘try harder’ or removing the offending individual. Rather, risk reduction usually requires process redesign to make the ‘right’ thing easier to do and an error less likely.

• 5

  Patient safety should be monitored proactively in order to ascertain risks and assist assessment and refinement of interventions to improve patient safety.

• 6

  An open, communicative culture that promotes reporting and minimizes blame supports patient safety improvement.