A safety culture key to reducing errors
ED leaders agree that creating a safety culture that reaches across all hospital departments is the key to improving safety in any department. Kevin Klauer, DO, FACEP, director of quality and clinical education for Emergency Medicine Physicians, Canton, OH, and a staff emergency physician at Barberton Citizens Hospital and Lodi Community Hospital, both in the Akron/Canton area, has identified several key elements of such a culture.
"Everyone talks about safety, but people do not always do what they say," he says. "The organizational values are not matched by the operation of the institution." Patient safety should be the first priority, Klauer adds. "The translation is, it has to be an agenda item on everyone's meetings."
What's more, he adds, "Your culture has to be blameless — and not just for doctors or nurses. Errors are going to happen." Those errors do not make someone a bad doctor or a bad nurse, Klauer adds. "It's how we handle them that make us different," he says.
So, as an ED manager, the approach to staff who commit errors is to tell them you know they are committed to doing their best, and it is important to examine the incident to learn how to prevent it from happening again. That attitude must be reflected by upper management as well, Klauer says. "Your administrator has to say that 'we understand there is rarely an error made that is one-dimensional — that they are multifactorial,'" he says.
The final element — a patient-centered culture — is closely linked to having a consistent approach to safety throughout the institution. For example, notes Klauer, procedural sedation is an important issue for The Joint Commission. "My understanding is that they are concerned that it may be occurring in environments made unsafe by providers who are not properly trained," he says.
So, for example, procedural sedation is part of an ED physician's training, board certification, and standard of care. However, for some other departments, "It is a good idea to make sure the staff are trained and credentialed properly, so if you are going to do an endoscopy, you will not have a bad outcome," says Klauer.
That's where a single hospitalwide approach becomes critical, he says. "If you have 15 departments saying they do not need oversight, you can have a huge breakdown, which can result in bad patient care," says Klauer. "Some patients may be getting a shoulder reduced without sedation in some institutions. You can't have 15 different definitions of what quality and safety are."
ED leaders agree that creating a safety culture that reaches across all hospital departments is the key to improving safety in any department.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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