Patient Safety in Emergency Medical Departments: A Systematic Review

Abstract

Introduction: Emergency medicine is a complex and high-risk specialty, and the environment of the emergency department (ED) is significantly different from traditional care environments such as ambulances, operating rooms, and outpatient clinics. The main objective of this review is to examine the impact of emergency department (ED) overcrowding on patient safety and public health, as well as to identify the various contributing factors and potential solutions to the overcrowding crisis.

Methods: Systematic searches were conducted in October 2022 using the databases MEDLINE (EBSCO), PubMed, CINAHL (EBSCO), and EMBASE (OVID). The searches were not limited by year of publication and included all types of peer-reviewed systematic reviews, as well as quantitative or qualitative studies in real clinical practice or simulation situations. After full-text inclusion, reference lists were hand-searched to identify relevant studies. All articles were screened on title and abstract by two independent reviewers. The search strategies used in this study were designed to identify terms related to patient safety in the emergency department. Due to the heterogeneity of the studies in terms of patient populations, interventions, and outcomes, a meta-analysis was not feasible.

Results: The search yielded a total of 177 potential articles that were reviewed for relevance, and 23 articles were selected for this review. Some of these cases of delayed treatment resulted in unexpected deaths. the number of critically ill patients presenting to California emergency departments (EDs) increased by 59% from 2000 to 2020. In California, a 12.3% decrease in the number of EDs from 2000 to 2010 led to a 27% increase in the number of visits per ED. ED overcrowding was found to be a complex problem with roots in "issues of inpatient capacity, the inadequacy of alternatives for hospitalization, and hospital resource shortages.

Conclusions:  Much of the research on patient safety in emergency departments (EDs) has focused on errors, with the assumption that errors can lead to harm. However, it is becoming increasingly recognized that efforts to improve patient safety should focus on both preventing errors and preventing adverse events.