Health Policy Related to Patient Safety in ED
1EMERGENCY MEDICINE & TRAUMA, Society for Emergency Medicine,India / Dr Mehta Hospitals chennai, India
Health policies issues related to patient safety in ED
When we talk about patient safety ,evidences suggest that 98000 preventable deaths occur per year due to medical errors (IOM 1999) and its about 400,000 in 2013 (Journal of patient safety).The serous harms are 20 times more
The patient safety initiatives have prevented 15,000 deaths in 2014 (HHS report May 2014) however patient safety concerns remain a serious issue
Emergency departments in our hospitals are high risk areas for compromise in
patient safety and prone for errors due to their very nature of its functioning.
It is important for all to understand how Emergency Units are different from any
others and why it is prone for high risk and errors.
All Emergency Units are comparatively open access area 24x7 with limited
Security control and it is Impossible to have controlled access entry like an OT or
ICU. Impossible to provide PPEs to all visitors and relatives to protect from cross
infection. Clinically not possible to differentiate and isolate communicable diseases from
the very start as evaluation and diagnosis is not fully available.
Over crowding.Blood spills from bleeding patients like trauma, Body fluid spills over bed/floor.
Inadequate manpower. Lack of adequate specialist and skilled doctors, Nurses,Paramedics trained in handling Emergencies.
Bounded rationality of decision making by Emergency Doctors and Staffs. Un-realistic demand and expectations from the attenders.
Not possible to shut down the unit and follow any full disinfection procedures as in ICU or OT. No clearly defined Emergency department structure, process, and clinical protocols suitable for our country and disease patterns. Multiple transitions (Ambulance personal to staff nurse, Nurse to Nurse, nurse
to Doctor, Doctor to nurse, Doctor to doctor) all within a very short time. Little or no time for case transition (Handover) during shift change. Very few units with a flat hierarchy culture. Physically, Mentally and emotionally tiring for Healthcare providers in the unit.
Risk taking behavior of staff. Minimal budget allocation as it is considered “Cost” Unit, not revenue unit.
Additional responsibilities on the unit in handling MCI.
All these are a complete recipe for disaster in patient safety!
Some of the unique quality and safety risks from the subcontinent region like India araise due to factors (mostly non modifiable) are Mode of patient retrial from site and transport,Neglect,Fall,Payment issues and poor insurance coverage,HIC - lack of awareness and safe practices ,Cultural hierarchy , Regulatory compliances,Law or lack of clear law,Support service availability and cover,Complexity in clinical decision making due to social,cultural and financial restrictions,Communication barrier,Skilled manpower shortage,Training,Poor supervision,Lack of quality culture,Under or no reporting due to fear of punishment,Equipment availability/utility/failure,Lack of compulsory accreditation for quality and patient safety,