Identifying patients with suicidal ideation can be a challenging clinical problem in the emergency department. These authors use a systems-based approach to identify missed opportunities to prevent suicide and present a systems approach to suicide prevention including three core domains – a culture of safety and prevention, applying best practices and policies for prevention in systems, and workforce education and development.

Patients who present to the emergency department (ED) with suicidal ideation can benefit from ED-initiated interventions, but interventions can be difficult to implement and maintain. This research builds on a 2013 study, describing the quality improvement (QI) methods used to implement the Emergency Department Safety Assessment and Follow-up Evaluation 2 (ED-SAFE 2) trial. The QI approach was successful in reducing death by suicide and suicide-related acute care during the study period.

In this retrospective study, researchers used electronic health record and quality assurance issue (QAI) data to analyze risk factors associated with patient safety events in the emergency department (ED). Multivariable analyses showed several potential risk factors for safety events – including length of time in the ED, which increased the odds of a safety event by 4.5% for each hour spent in the ED.

… practice nurses are defendants. … Myers LC, Sawicki D, Heard L, et al. A description of medical malpractice claims involving …

This article describes the implementation of the Emergency Department Safety Assessment and Follow-up Evaluation (ED-SAFE) Secondary Screener among adult patients at eight emergency departments (EDs) in seven states from August 2010 through November 2013. Of 1,376 patients endorsing active suicidal ideation or recent suicide attempt, most were positive for at least one indicator on the ED-SAFE screener. Based on score, the research team stratified patients at mild-, moderate-, or high-risk for suicide and these strata were associated with significantly different rates of suicidal behavior and attempts after 12 months of follow-up. The researchers recommend additional validation studies and removing elements with less predictive value to increase utility of this screening tool in the ED. 

Research has suggested that health care providers’ emotions may impact patient safety. These authors conducted 86 semi-structured interviews with emergency department (ED) nurses and physicians to better understand their emotional triggers, beliefs about emotional influences on patient safety, and emotional management strategies. Patients often triggered both positive and negative emotions; hospital- or systems-level factors primarily triggered negative emotions. Providers were aware that negative emotions can adversely impact clinical decision-making and place patients at risk; future research should explore whether emotional regulation strategies can mitigate these safety risks.

… of emergency medicine … Ann Emerg Med … Misdiagnosis of a neurologic emergency such as stroke can lead to serious morbidity or mortality. Using a large multi-state database, this study examined the … neurological event after ED discharge. Extrapolated to a national level, this translates to over 55,000 patients …

This retrospective cohort study of 16,801 patients examined whether patients in alternative care areas like hallways experienced more safety problems, such as intensive care unit transfer, readmission, and hospital-acquired infections. Investigators found that patients in alternative care areas were younger, had fewer comorbid health conditions, and no increase in risk for adverse safety outcomes. The results suggest that bed management takes into account patient acuity when assigning location to mitigate potential safety concerns.

In this study, better safety climates in emergency departments were associated with more intercepted near misses but not with fewer preventable adverse events.

Emergency department (ED) crowding was strongly associated with an increased risk of preventable medical error, in this study conducted in four Massachusetts EDs.

Adoption of computerized provider order entry (CPOE) remained low in this survey of emergency departments in four states, with only 30% of respondents having implemented CPOE.

… et al. The safety of emergency care systems: Results of a survey of clinicians in 65 US emergency departments.  Ann …

… Med … The authors describe the process used to implement a national epidemiological study of medical error in emergency departments. … Sullivan AF, Camargo CA Jr, Cleary PD, et al. The National Emergency …