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.

Children with emergent care needs are often cared for in complex situations that can diminish safety. This joint policy statement updates preceding recommendations to enhance the safety of care to children presenting at the emergency department. It expands on the application of topics within a high-reliability framework focusing on leadership, managerial factors, and organizational factors that support safety culture and workforce empowerment to support safe emergency care for children.

… of transgender youths in accessing health care: a systematic review. JAMA Pediatr. Epub 2021 Jul 19. …

While rare, surgical never events can have tragic consequences for patients including permanent harm and death. This study analyzed 142 surgical never events reported to the California Department of Public Health. Retained foreign objects were the most commonly reported never event (66.2%), followed by wrong site or wrong patient (15.5%), and surgical burns (7.7%). Recommended strategies to reduce and prevent never events include proper use of intraoperative checklists.

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.

This retrospective cohort study based on medical malpractice claims from 2007-2016 explored the characteristics of paid claims in which physician assistants and advanced practice nurses are defendants.

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. 

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 likelihood of readmission or inpatient mortality among patients who were initially discharged with nonspecific diagnoses of headache or back pain and found that 0.5% of headache and 0.2% of back pain patients experienced an inpatient death or serious neurological event after ED discharge. Extrapolated to a national level, this translates to over 55,000 patients with adverse outcomes due to a missed diagnosis for headache or back pain.

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 …