Emergency room crowding is a persistent factor that degrades safety for patients of all ages. This collection provides background, best practices, and recommendations to reduce emergency department crowding and its negative impact on pediatric care. The publications examine factors that influence crowding and improvement at the input, departmental, and hospital/outpatient stages of emergency care.

Cognitive aids, such as checklists and decision aids, can reduce omissions in care and improve patient safety. This systematic review including 13 randomized trials found that cognitive aids in clinical emergencies reduced the incidence of missed care steps (from 43% to 11%) and medical errors, and improved teamwork, non-technical, and conflict resolution scores.

Research with medical and surgical residents has shown they are frequently reluctant to speak up about safety and unprofessional behavior they observe. This study asked emergency medicine residents about their speaking up behaviors. Using the Speaking Up Climate (SUC)-Safe and SUC-Prof surveys, residents reported generally neutral responses to speaking up, more favorable than their medical and surgical counterparts. In line with other studies, residents were more likely to speak up about patient safety than about unprofessional behaviors.

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.

Nontechnical skills, such as teamwork and communication, are critical to safe care delivery, but can be difficult to measure. This systematic review examined validated approaches for assessing nontechnical skills using direct observation. Researchers analyzed 118 articles that discussed 76 unique tools for measuring nontechnical skills. This wide range of instruments assessed individuals or teams in various health care settings, either in simulation or actual clinical practice. They identified substantial variability in how these approaches were validated and whether individual studies reported the usability of each tool. The authors spotlight the need for standardization in how to develop, test, and implement assessments of nontechnical skills. A related editorial discusses the findings of this systematic review in the context of previous research and advocates for future work to standardize assessment of nontechnical skills in health care.

This revised set of guidelines suggests standards to ensure high-quality care for pediatric patients in the emergency department, including a section on improving patient safety. Key recommendations focus on pediatric emergency care coordinators and implementing quality control mechanisms.

Emergency departments harbor conditions that can hinder safe medication administration for pediatric patients. This policy statement identifies and prioritizes improvements such as implementing kilogram-only weight-based dosing, involving pharmacists in frontline emergency care, and utilizing computerized provider order entry and clinical decision support systems.

Health care has adopted safety concepts from high-risk industries such as process improvement and teamwork. This commentary describes lessons from industry regarding fatigue management strategies, spotlights the influence of cultural norms on fatigue in medicine, and suggests opportunities to research risks of fatigue in health care.

… death and how the mistake may be disclosed to the patient's clinical team and family. …

This study examined curricula across multiple specialties and found significant gaps in education related to team training, decision-making, and situational awareness. The authors call for standardized terminology and assessments to facilitate uniform uptake of these skills as part of medical education.

Nursing staff introduced a hand hygiene–themed game, jingle, and music video to improve hand hygiene compliance on their unit.

This policy statement describes ten principles developed to address quality gaps in transitions of care between inpatient and outpatient settings. Recommendations include coordinating clinicians, having a transition record, standardizing communication formats, and using evidence-based metrics to monitor outcomes.