Emergency Department (ED) crowding can contribute to clinically significant delays in diagnosis and recognition of deteriorating patients. A checklist to maintain patient safety in crowded EDs was developed and tested at University Hospitals Bristol NHS FT with support from the Health Foundation, and implemented in six hospitals and one ambulance trust in the West of England supported by the West of England Academic Health Sciences Network (WEAHSN). The checklist is a time-based series of tasks designed to keep track of all patients and alert staff to deterioration. Checklists have been shown to be effective in other areas of hospital care, but research on their use in the ED is limited.
NIHR CLAHRC West evaluated the ED safety checklist’s impact on patient safety using a mixed methods design. Results indicated that staff recognised the value of the checklist in enabling them to keep track of all patients in the ED, providing prompts and reminders, and ensuring patient safety when the demands of the ED could divert their attention. However, at extreme peaks of demand, the ED checklist was not always used. Analysis of key-performance-indicator data suggested that when the ED checklist was used as intended, the documentation of patient care was improved. The researchers concluded that implementation requires careful planning, preferably when the ED is not under pressure, so that it can be integrated into existing documentation and workflows, and it needs to be supported by senior members of the ED multidisciplinary team as well as senior hospital leaders.
In October 2017, NHS Improvement issued a recommendation to all trusts in England to implement the ED checklist
Contribution of CLAHRC West
The NIHR CLAHRC West team designed and conducted the mixed-method evaluation of the ED checklist in collaboration with the WEAHSN. The findings are being used to refine implementation and roll-out of the ED checklist, and CLAHRC West is collaborating with the WEAHSN in the development of an ED safety checklist ‘toolkit’ to support implementation and roll-out across the NHS.
What happened next?
In October 2017, NHS Improvement issued a recommendation to all trusts in England to implement the ED checklist, and Channel 4 News featured this on its main evening programme. The West of England Emergency Department Collaborative won the HSJ Patient Safety Award in 2017. The Kings Fund report ‘Adoption and Spread in the NHS’ published in February 2018 highlighted the ED checklist as a patient safety innovation. A paper on the evaluation has been submitted to BMJ Quality and Safety.