Patient Safety Study: Adverse Events Related to Emergency Department Care
Overview
Emergency departments are areas of high patient acuity with increasing pressures in terms of overcrowding and limited resources. This is the area of the hospital that represents the gateway to the health care system. Understanding that large numbers of patients need to be triaged, assessed, diagnosed and treated in a short period of time with limited information leads one to intuitively conclude that it is a ripe environment for patient safety concerns. Patients are unstable, undifferentiated and unscheduled. The complexity of the patient encounter in the emergency department has been previously described and this contributes to the challenge of determining risk factors for preventable adverse events.
Principal Investigator: Dr. Lisa Calder
Co-Investigators: Dr. Alan Forster, Dr. Ian Stiell, Dr. George Wells
Duration of Study: Enrollment complete; currently being submitted for publication
For more information, please contact Dr. Lisa Calder.
Protocol Summary
Background
Since the emergency department is a potentially high risk environment where
the consequences of adverse events can be severe,
patient safety should be a priority area of emergency medicine research.
Few studies have been performed in this area to date.
This prospective cohort study will contribute new knowledge about the unique population
of those patients triaged to high acuity areas of the emergency department.
By determining a method of prospectively measuring adverse events,
we can better understand the contributing system issues and
use these tools to test interventions to reduce preventable adverse events in the future.
Objectives
To determine the incidence of adverse events among patients discharged (home or admitted to the floor)
from high acuity areas of the emergency department (ED).
To describe the causes of adverse events and identify populations at risk.
Methods
This is a dual-center prospective analytic cohort study using a stratified random sampling scheme of specific time frames.
The study setting are the resuscitation and observation areas of the two EDs of The Ottawa Hospital,
representing approximately 55,000 patient visits/year.
All consecutive patients older than age 18 capable of providing informed consent or
who have a suitable substitute decision maker present are enrolled.
Only those discharged from the ED who are able to complete a telephone interview in 2 weeks in English or French will be included.
Baseline data is collected at enrolment.
A structured telephone interview is conducted 10-14 days after discharge.
For those patients admitted, their charts are reviewed.
Case summaries are constructed to include: the ED record of treatment, baseline and
telephone follow-up data as well as any inpatient charts.
Three emergency physicians, blinded to the identity of the patient and treating physician,
will assess all flagged outcomes and classify them as adverse events, preventable or un-preventable.
These preventable adverse events will further be classified as diagnostic issues, management issues,
medication adverse effects or procedural complications.
The primary outcome is a preventable adverse event.
This can include new/worsening symptoms, an unscheduled return emergency department visit,
unscheduled admission to hospital or unexpected death.
Importance
It is anticipated that this study will be the first to rigorously assess the incidence
of adverse events among patients discharged from the emergency department.
This represents an important advance in understanding patient safety issues in
the emergency department, a burgeoning field.
The results will be interpreted in the context of current patient safety and
human factors engineering literature.
Future directions could include surveying emergency physicians to identify risk factors
among health care providers for contributing to adverse events,
implementing an anonymous reporting system, developing reporting software and
modifying shift handover practices to reduce risks of adverse events.
Additional Information
None at this time.
Team Members
- OHRI members:
-
Dr. Alan Forster, Thesis Supervisor
Dr. Ian Stiell, Thesis Supervisor
Dr. George Wells, Thesis Supervisor
Ms. Melanie Courtney, Research Assistant
Mr. Jason Leclair, Research Assistant