Are EDs unsafe? Survey says 'yes'

Emergency departments are currently unsafe places for both professionals and patients, according to a survey carried out for the European Society of Emergency Medicine (EUSEM).

Staff shortages and overcrowding due to the non-availability of beds in wards necessitating the provision of care in corridors were found to be the key reasons. 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.

Respondents to the survey also felt that they had insufficient support from hospital management. Around 90% of professionals surveyed felt that at times the number of patients in ED exceeded the capacity of the department to provide safe care, and that such overcrowding was a regular problem. In addition to causing patient and professional discomfort and impeding their ability to provide care, overcrowding is known to carry a substantial risk of harm and increased mortality.

Nurses who responded to the survey felt less safe than did doctors, particularly with regard to the environment in which they had to treat patients with mental health problems. Since in general they work with patients for longer periods of time, this is understandable, but nonetheless troubling, the researchers said.

“Last year’s EUSEM survey into burnout among ED professionals was worrying enough,” said EUSEM President Dr James Connolly, “showing as it did that younger and less experienced EM professionals were more likely to be affected than older, more experienced staff. It is very disquieting to see this pattern repeated, and completely unacceptable that so little action has been taken to remedy it. If anything, the situation appears to be worse than before.” This is especially important, as in many EDs the majority of professionals are still junior and therefore at greater risk of burnout, and so in greater need of supervision to protect both themselves and their patients.

Although targets have been advantageous in bringing about improvements in the past, the current feedback from ED staff shows that, when systems are under significant strain, they feel pressurised by the imposition of such external targets and believe this could cause patient care to suffer.

Some 54.2% said they were permanently under external pressure. Support from hospital management was also perceived to be inadequate, with 35% of professional responders reporting that hospital managers never supported the introduction of improvements, and 47% thinking that procedures for improving flow in the ED were never effective.

The research has been published in the European Journal of Emergency Medicine¹.The preliminary findings of a survey among patients, yet to be published, were even more alarming. More patients thought that ED staff were “angry” or “rude” than were kind. This is likely to be caused by exhaustion and frustration, said an accompanying editorial² from Connolly, “given that the vast majority of those responding to the survey of professionals said that they were proud to work in an ED”. Among responses received, a typical statement was, “There were a lot of patients and very few doctors. Some nurses were very stressed.”

Alarmingly, some patients surveyed felt so concerned about their safety in the ED that they said they would prefer not to go there at all, believing that overcrowding, long waiting times and exhausted staff would lead to medical errors.

“Dedicated professionals need the right environment and support in which to carry out their work, and patients need to feel reassured that they will get the best treatment. Currently we are far from that being the case. Governments and healthcare authorities must remedy this now, before the situation worsens further when it may become too late to arrest the spiral of decline,” Connolly said.

^{1.DOI 10.1097/MEJ.0000000000001044}

^{2.DOI 10.1097/MEJ.0000000000001048}

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