The 2 Greatest Threats to Patient Safety in the ED

Threats to Patient Safety Donovan and Partners

Emergency departments face several threats when it comes to patient safety and quality but the top two are overcrowding and a shortage of on-call specialists, according to the American College of Emergency Physicians (ACEP).

Cut the Crowds: It is Not Always a Staffing Shortage Issue

Overcrowding is a well-known problem — there are news reports every week about how EDs are short on beds, and how patients are unable to receive the treatment they need because of it. Hospitals often tackle the problem with multi-million dollar expansions, ambulance diversions or by bringing on additional staff. Sometimes these solutions work; many times they don’t.

As health care professionals we know treating a patient’s symptoms only provides temporary relief. For example, it’s not the recurring headache that’s the problem; it’s what causes these headaches that we need to be concerned with. We have to do the same type of digging to diagnose a troubled ED.

To remedy overcrowding we have to look at it as a symptom with a wide variety of potential root causes, none of which are necessarily universal. Just because one ED is overcrowded because of “boarding” — which ACEP suggests is the primary cause — doesn’t mean that another ED facing a shortage of beds is having trouble for the same reason.

Look Beyond Boarding Issues

While boarding may be the predominate cause of overcrowding for a vast number of EDs, it too, is just a symptom of even more underlying problems. Maybe the ED across town closed recently, or your area is in the grasps of an opioid epidemic. Overcrowding could be a result of inefficient staffing in the ED, or inopportune scheduling of in-patient surgery in the hospital itself. When it comes to overcrowding there are a wide variety of causes — and combination of causes — that could be at the root. And in order to remedy it, a dynamic and tailored plan of action has to be implemented.  

What’s Causing the Specialist Shortage?

This same idea holds true for the shortage of on-call specialists. At the root of this shortage of neurologists, trauma and orthopedic surgeons, and the like, isn’t that there’s an actual decrease in the number of specialists able to treat patients. It’s because these specialists are often opting out of on-call responsibilities, typically mandated by EMTALA, by leaving the hospital setting. So the solution isn’t more specialists — it’s encouraging the ones we already have on staff to stay.

Again, the shortage of on-call specialists is a symptom of deeper issues. Specialists aren’t leaving the hospital setting because they don’t care about these patients or don’t want to treat them. According to ACEP, it’s typically because:

  • they believe there’s an increased liability that exists when working in the ED;
  • or that they think on-call pay is inadequate;
  • or because of the quality of life concerns that stem from being on call.

Be a Detective — Dig!

When it comes to these two threats to patient safety and quality, we have to remove our blinders. It takes a broad view with many sets of eyes to identify the real issues that inhibit our ability to deliver the safe and quality care our patients deserve. Threats like overcrowding and a lack of on-call specialists are obvious, but in many instances, the roots of the problems remain buried. In order to solve these problems, we have to dig them up.

If you need help getting to the bottom of challenges in your ED, drop me a line. I’d be honored to chat about how I might be of help. And, for a broad look at the services my consulting agency provides, check out our website:

American College of Emergency Physicians: “Patient Safety and Quality of Emergency Care.”
American College of Emergency Physicians: “Study: Shortage of On-Call Specialists Spreads Nationally Could 'cripple' emergency, trauma care.”
Nathan R. Hoot, PhD, and Dominik Aronsky, MD, PhD: “Systematic Review of Emergency Department Crowding: Causes, Effects, and Solutions.