New ED Clinicians Pose Safety Concerns
June 1, 2024
Newly trained clinicians entering clinical practice are the top patient safety concern in healthcare, according to ECRI’s Top 10 Patient Safety Concerns for 2024 Special Report.1
Shannon Davila, MSN, RN, executive director of Total Systems Safety at ECRI, says that EDs can mitigate risks with these approaches:
• Offering both hands-on learning and simulation-based learning for issues such as behavioral health, sepsis, diagnostic testing, and safety and security. “It depends on the resources of the organization. But a hybrid model of training is ideal for skill development for more complex issues like these,” says Davila.
• Creating more opportunities for senior ED clinicians to precept new clinicians. This requires hospital leadership to allow ED clinicians to have designated time to work alongside new clinicians. “With a limited time of training overseen by experienced clinicians, new clinicians can gain experience and confidence in order to meet practice standards,” advises Davila.
• Involving interdisciplinary teams to help new clinicians understand complex issues. Examples of these skills include recognizing how bias can lead to diagnostic errors, and professional and personal skills such as leadership, communication, decision-making, situational awareness, managing stress, and coping with fatigue.
“Experienced ED clinicians can work with their clinical education department and safety/risk teams to coordinate education that addresses high-risk issues,” says Davila.
• Aligning competency-based training programs with guidance from professional organizations.
• Building a culture of safety within the ED that empowers newly trained clinicians to report safety events that affect them, their coworkers, and patients. EDs can do this by holding events highlighting unsafe working conditions or the risks of performing tasks outside the clinician’s competency.
Next, EDs can monitor the effect of these actions with data from a culture of safety survey that is specific to the ED setting.
“They can drill into the data at the ED level. There are questions about teamwork, communication, and leadership that can help ED leaders measure the impact of their improvement actions,” offers Davila.
New ED clinicians may not recognize subtle changes or unusual presentation of a serious disease. Robert W. Derlet, MD, professor emeritus in the ED at UC Davis, reviewed a malpractice case involving a recent graduate from an emergency medicine training program. “The patient had a subtle presentation of sepsis but was discharged with a diagnosis of hyperventilation,” reports Derlet.
Additionally, new ED clinicians may not consider that a laboratory value might be wrong. For example, a patient might be diagnosed with an upper respiratory infection with a COVID-19 test that is a false-negative and requires hospitalization. An experienced ED clinician would be more likely to consider the possibility of the test being a false-negative, explains Derlet.
New ED clinicians may remember to repeat the patient’s vital signs at regular intervals but ignore the fact that the patient has had nothing to drink. Thus, patients may linger in the ED without food or water for more than 12 hours, resulting in dehydration and worsening of conditions. “In addition, overwhelming conditions in the ED are difficult to adjust to, priorities may be confused, or patients even forgotten because the staff are busy with other patients,” says Derlet.
Derlet suggests these approaches to reduce risks:
• Integrate new staff into the ED over several weeks, so they are not given full responsibilities during the first shifts.
• Team up new staff with a seasoned staff member who work together as a buddy system.
“Yes, this is expensive and difficult — but important. In the long run, it will pay off with better patient care and less risk for a malpractice action,” according to Derlet.
REFERENCE
- ECRI. Top 10 Patient Safety Concerns 2024. https://www.ecri.org/top-10-patient-safety-concerns-2024
Newly trained clinicians entering clinical practice are the top patient safety concern in healthcare, according to ECRI’s Top 10 Patient Safety Concerns for 2024 Special Report.
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