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Perspectives on Safety > Perspective
with commentary by David P. Sklar, MD; Cameron Crandall, MD, Patient Safety in Emergency Medicine, June 2010
Emergency medicine has evolved from a location, with variably trained and experienced providers ("the ER"), to a discipline with a well-defined knowledge base and skill set that focus on the diagnosis and care of undifferentiated acute problems.(1) The importance of rapid diagnosis and treatment of serious conditions (e.g., myocardial infarction, stroke, trauma, and sepsis) has made timeliness not simply a determinant of patient satisfaction but also a significant safety and quality concern—delays in care can be deadly.(2) Emergency physicians (EPs) have identified delays caused by crowding from boarding of admitted patients as their most significant safety problem.(3) We present a model for understanding emergency department (ED) patient safety and identify solutions by deconstructing care into three realms: individual provider, patient, and environmental system (Table).
Dublin, Ireland: Irish Society for Quality & Safety in Healthcare; 2005.
This report provides results from a 26-hospital survey investigating areas of service and care weakness in Irish hospitals. The research revealed problems related to information transfer, overwork, and lack of patient involvement in decision making about their care.
Journal Article > Study
Hutter MM, Kellogg KC, Ferguson CM, Abbott WM, Warshaw AL. Ann Surg. 2006;243:864-871; discussion 871-875.
Since implementation of Accreditation Council for Graduate Medical Education (ACGME) resident duty hour restrictions, several studies have discussed the changes from a policy standpoint, a cost perspective, and with respect to patient safety. This study discovered that although resident quality of life improved, there was no impact on quality of patient care, and several concerns were raised about the training of future surgeons. These concerns included a change toward a shift-worker mentality with less patient focus, decreased continuity of care, and erosion of the doctor-patient relationship. Investigators used a combination of time card assessments, Web-based surveys, and individual interviews to draw their conclusions.
Holt TE. Men's Health. November 3, 2006.
This series includes articles on "doorway diagnosis" (or a doctor's assessment of a patient before an exam begins), anesthesiologists addicted to painkillers, and medical mistakes in the emergency room.
Journal Article > Commentary
Nurok M, Czeisler CA, Lehmann LS. N Engl J Med. 2010;363:2577-2579.
This commentary discusses complications with rescheduling elective procedures due to surgeon sleep deprivation and encourages the evaluation of policy solutions to inform patients and families of provider fatigue.