Consensus-based Recommendations for Research Priorities Related to Interventions to Safeguard Patient Safety in the Crowded Emergency Department

Authors

  • Christopher Fee MD,

    1. From the Department of Emergency Medicine, University of California, San Francisco (CF), San Francisco, CA; the Agency for Healthcare Research and Quality (KH), Rockville, MD; Brandeis University (JBM), Waltham, MA; Georgetown University (RS, RJF, JA), Washington, DC; MedStar Health (RS, RJF), Columbia, MD; Rush Medical College (KC), Chicago, IL; Loyola University (RY), Chicago, IL; the Emergency Nurses Association, Des Plaines, IL, and Massachusetts General Hospital (GL), Boston, MA; Emergency Medicine Physicians (KO), Gastonia, NC; and the University of Florida (RW), Gainesville, FL.
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  • Kendall Hall MD,

    1. From the Department of Emergency Medicine, University of California, San Francisco (CF), San Francisco, CA; the Agency for Healthcare Research and Quality (KH), Rockville, MD; Brandeis University (JBM), Waltham, MA; Georgetown University (RS, RJF, JA), Washington, DC; MedStar Health (RS, RJF), Columbia, MD; Rush Medical College (KC), Chicago, IL; Loyola University (RY), Chicago, IL; the Emergency Nurses Association, Des Plaines, IL, and Massachusetts General Hospital (GL), Boston, MA; Emergency Medicine Physicians (KO), Gastonia, NC; and the University of Florida (RW), Gainesville, FL.
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  • J. Bradley Morrison PhD,

    1. From the Department of Emergency Medicine, University of California, San Francisco (CF), San Francisco, CA; the Agency for Healthcare Research and Quality (KH), Rockville, MD; Brandeis University (JBM), Waltham, MA; Georgetown University (RS, RJF, JA), Washington, DC; MedStar Health (RS, RJF), Columbia, MD; Rush Medical College (KC), Chicago, IL; Loyola University (RY), Chicago, IL; the Emergency Nurses Association, Des Plaines, IL, and Massachusetts General Hospital (GL), Boston, MA; Emergency Medicine Physicians (KO), Gastonia, NC; and the University of Florida (RW), Gainesville, FL.
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  • Robert Stephens PhD,

    1. From the Department of Emergency Medicine, University of California, San Francisco (CF), San Francisco, CA; the Agency for Healthcare Research and Quality (KH), Rockville, MD; Brandeis University (JBM), Waltham, MA; Georgetown University (RS, RJF, JA), Washington, DC; MedStar Health (RS, RJF), Columbia, MD; Rush Medical College (KC), Chicago, IL; Loyola University (RY), Chicago, IL; the Emergency Nurses Association, Des Plaines, IL, and Massachusetts General Hospital (GL), Boston, MA; Emergency Medicine Physicians (KO), Gastonia, NC; and the University of Florida (RW), Gainesville, FL.
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  • Karen Cosby MD,

    1. From the Department of Emergency Medicine, University of California, San Francisco (CF), San Francisco, CA; the Agency for Healthcare Research and Quality (KH), Rockville, MD; Brandeis University (JBM), Waltham, MA; Georgetown University (RS, RJF, JA), Washington, DC; MedStar Health (RS, RJF), Columbia, MD; Rush Medical College (KC), Chicago, IL; Loyola University (RY), Chicago, IL; the Emergency Nurses Association, Des Plaines, IL, and Massachusetts General Hospital (GL), Boston, MA; Emergency Medicine Physicians (KO), Gastonia, NC; and the University of Florida (RW), Gainesville, FL.
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  • Rollin (Terry) J. Fairbanks MD,

    1. From the Department of Emergency Medicine, University of California, San Francisco (CF), San Francisco, CA; the Agency for Healthcare Research and Quality (KH), Rockville, MD; Brandeis University (JBM), Waltham, MA; Georgetown University (RS, RJF, JA), Washington, DC; MedStar Health (RS, RJF), Columbia, MD; Rush Medical College (KC), Chicago, IL; Loyola University (RY), Chicago, IL; the Emergency Nurses Association, Des Plaines, IL, and Massachusetts General Hospital (GL), Boston, MA; Emergency Medicine Physicians (KO), Gastonia, NC; and the University of Florida (RW), Gainesville, FL.
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  • Barbara Youngberg MSW, JD,

    1. From the Department of Emergency Medicine, University of California, San Francisco (CF), San Francisco, CA; the Agency for Healthcare Research and Quality (KH), Rockville, MD; Brandeis University (JBM), Waltham, MA; Georgetown University (RS, RJF, JA), Washington, DC; MedStar Health (RS, RJF), Columbia, MD; Rush Medical College (KC), Chicago, IL; Loyola University (RY), Chicago, IL; the Emergency Nurses Association, Des Plaines, IL, and Massachusetts General Hospital (GL), Boston, MA; Emergency Medicine Physicians (KO), Gastonia, NC; and the University of Florida (RW), Gainesville, FL.
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  • Gail Lenehan EdD, MSN, RN,

    1. From the Department of Emergency Medicine, University of California, San Francisco (CF), San Francisco, CA; the Agency for Healthcare Research and Quality (KH), Rockville, MD; Brandeis University (JBM), Waltham, MA; Georgetown University (RS, RJF, JA), Washington, DC; MedStar Health (RS, RJF), Columbia, MD; Rush Medical College (KC), Chicago, IL; Loyola University (RY), Chicago, IL; the Emergency Nurses Association, Des Plaines, IL, and Massachusetts General Hospital (GL), Boston, MA; Emergency Medicine Physicians (KO), Gastonia, NC; and the University of Florida (RW), Gainesville, FL.
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  • Jameel Abualenain MD,

    1. From the Department of Emergency Medicine, University of California, San Francisco (CF), San Francisco, CA; the Agency for Healthcare Research and Quality (KH), Rockville, MD; Brandeis University (JBM), Waltham, MA; Georgetown University (RS, RJF, JA), Washington, DC; MedStar Health (RS, RJF), Columbia, MD; Rush Medical College (KC), Chicago, IL; Loyola University (RY), Chicago, IL; the Emergency Nurses Association, Des Plaines, IL, and Massachusetts General Hospital (GL), Boston, MA; Emergency Medicine Physicians (KO), Gastonia, NC; and the University of Florida (RW), Gainesville, FL.
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  • Kevin O’Connor MD,

    1. From the Department of Emergency Medicine, University of California, San Francisco (CF), San Francisco, CA; the Agency for Healthcare Research and Quality (KH), Rockville, MD; Brandeis University (JBM), Waltham, MA; Georgetown University (RS, RJF, JA), Washington, DC; MedStar Health (RS, RJF), Columbia, MD; Rush Medical College (KC), Chicago, IL; Loyola University (RY), Chicago, IL; the Emergency Nurses Association, Des Plaines, IL, and Massachusetts General Hospital (GL), Boston, MA; Emergency Medicine Physicians (KO), Gastonia, NC; and the University of Florida (RW), Gainesville, FL.
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  • Robert Wears MD

    1. From the Department of Emergency Medicine, University of California, San Francisco (CF), San Francisco, CA; the Agency for Healthcare Research and Quality (KH), Rockville, MD; Brandeis University (JBM), Waltham, MA; Georgetown University (RS, RJF, JA), Washington, DC; MedStar Health (RS, RJF), Columbia, MD; Rush Medical College (KC), Chicago, IL; Loyola University (RY), Chicago, IL; the Emergency Nurses Association, Des Plaines, IL, and Massachusetts General Hospital (GL), Boston, MA; Emergency Medicine Physicians (KO), Gastonia, NC; and the University of Florida (RW), Gainesville, FL.
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Errata

This article is corrected by:

  1. Errata: Erratum Volume 19, Issue 1, 112, Article first published online: 17 January 2012

  • Preconference working group members: Jameel Abualenain, Karen Cosby, Rollin J. (Terry) Fairbanks, Christopher Fee, Kendall Hall, Gail Lenehan, Brad Morrison, Kevin O’Connor, Robert Stephens, Robert Wears, and Barbara Youngberg.

  • CC session participants: James Amsterdam, Dominik Aronsky, Brent Asplin, Chandra Aubin, William Baker, Christopher Beach, John Becher, Russ Braun, Theodore Christopher, Fergal Cummins, Kevin Ferguson, Christina Gindele, Matthew Gratton, Jason Hack, Leon Haley, Jr., Kendall Hall, Peter Hill, Brian Holroyd, Kurt Isenberger, Renaldo Johnson, John Kelly, Richard Martin, Ryan Mutter, Marie-France Petchy, Timothy Reeder, Drew Richardson, Richard Ruddy, Caitlin Schaninger, Jeremiah Schuur, Robert Sherwin, Robert Shesser, Dell Simmons, and David Sklar.

  • This manuscript represents the consensus findings for the Interventions to Safeguard Safety component of the 2011 Academic Emergency Medicine Consensus Conference entitled “Interventions to Assure Quality in the Crowded Emergency Department (ED)” held in Boston, MA.

  • This paper does not represent the policy of either the Agency for Healthcare Research and Quality (AHRQ) or the U.S. Department of Health and Human Services (DHHS). The views expressed herein are those of the authors and no official endorsement by AHRQ or DHHS is intended or should be inferred.

  • Funding for this conference was made possible (in part) by 1R13HS020139-01 from the Agency for Healthcare Research and Quality (AHRQ). The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services, nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government. This issue of Academic Emergency Medicine is funded by the Robert Wood Johnson Foundation.

  • The authors have no disclosures or conflicts of interest to report.

  • Supervising Editor: James Miner, MD.

Address for correspondence and reprints: Christopher Fee, MD; e-mail: Christopher.Fee@ucsf.edu. Reprints will not be available.

Abstract

ACADEMIC EMERGENCY MEDICINE 2011; 18:1283–1288 © 2011 by the Society for Academic Emergency Medicine

Abstract

This article describes the results of the Interventions to Safeguard Safety breakout session of the 2011 Academic Emergency Medicine (AEM) consensus conference entitled “Interventions to Assure Quality in the Crowded Emergency Department.” Using a multistep nominal group technique, experts in emergency department (ED) crowding, patient safety, and systems engineering defined knowledge gaps and priority research questions related to the maintenance of safety in the crowded ED. Consensus was reached for seven research priorities related to interventions to maintain safety in the setting of a crowded ED. Included among these are: 1) How do routine corrective processes and compensating mechanism change during crowding? 2) What metrics should be used to determine ED safety? 3) How can checklists ensure safer care and what factors contribute to their success or failure? 4) What constitutes safe staffing levels/ratios? 5) How can we align emergency medicine (EM)-specific patient safety issues with national patient safety issues? 6) How can we develop metrics and skills to recognize when an ED is getting close to catastrophic overload conditions? and 7) What can EM learn from experts and modeling from fields outside of medicine to develop innovative solutions? These priorities have the potential to inform future clinical and human factors research and extramural funding decisions related to this important topic.

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