New paper published evaluating the Emergency Department checklist to enhance patient safety

A paper evaluating the introduction of the Emergency Department (ED) safety checklist in two UK hospital emergency departments has been published in the Journal of Clinical Nursing. The checklist allows clinicians to keep track of what should be done each hour for every patient coming into the department. This includes making sure that care needs are met such as calling relatives and offering drinks and food. It was introduced in the west of England region to help keep patients safe.

Use of this checklist (or an equivalent) is now supported and endorsed by NHS Improvement, NHS England, the Royal College of Emergency Medicine, the Royal College of Nursing and the Care Quality Commission. The West of England Academic Health Science Network (AHSN) led on the roll-out of the checklist both in the region and nationally.

ARC West researchers went into two of the hospitals where this system had been introduced to see how the checklist was used and to speak to doctors, nurses and other healthcare workers about their experiences of using it.

Staff generally thought that the ED checklist was useful in recording and communicating with each other on the medical state of a patient and what might need to be done. Most felt that it was a good prompt, especially if they were new to the department or in training.

Some staff felt that it duplicated work, as it recorded what they were already doing, and having another form to fill in added to their workload. Staff said that the checklist was least likely to be completed properly when the ED was very busy, even though this was when it was supposed to be most helpful for keeping track of patient safety.

From the interviews and observations, the researchers identified possible reasons for this. When the checklist was introduced it was also presented as a way of protecting staff if there was a complaint and to generate hospital audit data. While both messages are true, they obscured the checklist’s main function as a clinical tool to keep patients safe. The researchers also found that incorporating the document into existing paperwork and having the support of senior staff improved the acceptability of the checklist to ED staff.

Dr Jon Banks, who led the ARC West project, said:

“A key finding from our research is how important the framing of the toolkit is by the project team to the ED staff who’ll be completing it. The checklist is there for clinical reasons, to enhance patient safety, not just to collect auditing information or other admin tasks. If it’s explained in patient safety terms, it makes staff more likely to complete it during busy periods.”

Emma Redfern, Consultant in Emergency Medicine at University Hospitals Bristol and one of the clinicians behind the checklist, said:

“We’ve found the ED safety checklist to be enormously helpful at UH Bristol and welcome the recent evidence-informed update of it. The paper highlights that the best way to get the checklist to contribute to patient safety is to ensure it is incorporated into existing documentation and workflow, which is something I would endorse.”

The evidence also informed an update to the West of England AHSN’s toolkit which is used nationally to support NHS trusts implementing and monitoring their use of the checklist.

Paper

The introduction of a safety checklist in two UK hospital emergency departments: a qualitative study of implementation and staff use
Tracey Stone and Jon Banks, Heather Brant, Joanna Kesten, Emma Redfern, Ann Remmers, Sabi Redwood
Published in the Journal of Clinical Nursing
Tracey and Jon wish to be recognised as joint first authors