• Posted May 26, 2023

Are ERs Safe? Patients, Nurses and Doctors Say No in New Survey

Emergency departments aren't perceived as safe for professionals or their patients, according to an international survey from the European Society of Emergency Medicine (EUSEM).

More than 90% of emergency professionals surveyed said they felt at times the number of patients exceeded the capacity the emergency department (ED) had to provide safe care. Overcrowding was a problem, they said.

Overcrowding is known to carry substantial risk of harm and increased deaths, according to the society.

Preliminary results from a patient survey were even harsher, with more reporting that emergency staff were angry and rude than were kind, according to the report published May 25 in the European Journal of Emergency Medicine.

Among the issues were overcrowding and staff shortages, plus the need to provide care in corridors because of too few beds.

"Last year's EUSEM survey into burnout among ED professionals was worrying enough, showing as it did that younger and less experienced [emergency medicine] professionals were more likely to be affected than older, more experienced staff," said Dr. James Connolly, EUSEM president.

"It is very disquieting to see this pattern repeated, and completely unacceptable that so little action has been taken to remedy it. If anything, the situation appears to be worse than before,"Connolly said in an EUSEM news release.

In an editorial accompanying the study, Connolly said the behavior patients noted from staff was likely to be caused by exhaustion and frustration, "given that the vast majority of those responding to the survey of professionals said that they were proud to work in an ED."

A typical response to one of the surveys was, "There were a lot of patients and very few doctors. Some nurses were very stressed."

Nurse respondents felt less safe than doctors, especially in terms of treating patients with mental health problems. Nurses tend to work with patients for longer periods of time, but this is troubling, the researchers said.

Staff also noted that when systems are under significant strain, they feel forced to meet external targets that they think could cause patient care to suffer, according to the study.

About 54% of emergency staff said they were permanently under external pressure. About 35% said hospital management never supported the introduction of improvements, and 47% said procedures for improving flow in the department were never effective.

Some patients reported feeling so concerned about their safety in the ED that they would prefer not to go there at all. They expressed concern that overcrowding, long waiting times and exhausted staff would lead to medical errors.

"Dedicated professionals need the right environment and support in which to carry out their work, and patients need to feel reassured that they will get the best treatment. Currently, we are far from that being the case. Governments and health care authorities must remedy this now, before the situation worsens further when it may become too late to arrest the spiral of decline,"Connolly said.

More information

The American College of Emergency Physicians has more on creating safer environments for emergency staff.

SOURCE: European Society of Emergency Medicine, news release, May 25, 2023