title: The safety of emergency care systems: Results of a survey of clinicians in 65 US emergency departments.
abstract: OBJECTIVE
  Well-functioning systems are critical to safe patient care, but little is known about the status of such systems in US health care facilities, including high-risk settings such as the emergency department (ED). The purpose of this study is to assess the degree to which EDs are designed, managed, and supported in ways that ensure patient safety.
  
  
  METHODS
  This was a validated, psychometrically tested survey of clinicians working in 65 US EDs that assessed clinician perceptions about the EDs' physical environment, staffing, equipment and supplies, nursing, teamwork, safety culture, triage and monitoring, information coordination and consultation, and inpatient coordination.
  
  
  RESULTS
  Overall 3,562 eligible respondents completed the survey (response rate=66%). Survey respondents commonly reported problems in 4 systems critical to ED safety: physical environment, staffing, inpatient coordination, and information coordination and consultation. ED clinicians reported that there was insufficient space for the delivery of care most (25%) or some (37%) of the time. Respondents indicated that the number of patients exceeded ED capacity to provide safe care most (32%) or some of the time (50%). Only 41% of clinicians indicated that most of the time specialty consultation for critically ill patients arrived within 30 minutes of being contacted. Finally, half of respondents reported that ED patients requiring admission to the ICU were rarely transferred from the ED to the ICU within 1 hour.
  
  
  CONCLUSIONS
  Reports by ED clinicians suggest that substantial improvements in institutional design, management, and support for emergency care are necessary to maximize patient safety in US EDs.
authors.affiliation: Institute for Health Research, Kaiser Permanente Colorado and the Departments of Emergency Medicine and Preventive Medicine and Biometrics, University of Colorado Health Sciences Center, Denver, USA. david.j.magid@kp.org
authors.forename: David J
authors.initials: DJ
authors.lastname: Magid
authors.forename: Ashley F
authors.initials: AF
authors.lastname: Sullivan
authors.forename: Paul D
authors.initials: PD
authors.lastname: Cleary
authors.forename: Sowmya R
authors.initials: SR
authors.lastname: Rao
authors.forename: James A
authors.initials: JA
authors.lastname: Gordon
authors.forename: Rainu
authors.initials: R
authors.lastname: Kaushal
authors.forename: Edward
authors.initials: E
authors.lastname: Guadagnoli
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Camargo
authors.forename: David
authors.initials: D
authors.lastname: Blumenthal
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003625:Data Collection; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D017144:Focus Groups; D006801:Humans; D020407:Internet; D007396:Internship and Residency; D008297:Male; D008875:Middle Aged; D009722:Nurse Practitioners; D010823:Physician Assistants; D010820:Physicians; D019984:Quality Indicators, Health Care; D012308:Risk Management; D011795:Surveys and Questionnaires; D014481:United States; D055815:Young Adult