Published online July 27, 2009
PEDIATRICS Vol. 124 No. 2 August 2009, pp. 485-493 (doi:10.1542/peds.2008-2858)

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ARTICLE

Pediatric Patient Safety in Emergency Departments: Unit Characteristics and Staff Perceptions

Kathy N. Shaw, MD^a, Richard M. Ruddy, MD^b, Cody S. Olsen, MS^c, Kathleen A. Lillis, MD^d, Prashant V. Mahajan, MD, MBA^e, J. Michael Dean, MD, MBA^c, James M. Chamberlain, MD^f for the Pediatric Emergency Care Applied Research Network

^a Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
^b Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
^c Department of Pediatrics, University of Utah, Salt Lake City, Utah
^d Department of Pediatrics, Women and Children's Hospital of Buffalo, Buffalo, New York
^e Department of Pediatrics, Children's Hospital of Michigan, Detroit, Michigan
^f Department of Pediatrics, Children's National Medical Center, Washington, DC

OBJECTIVES: The goals were (1) to describe emergency department (ED) characteristics thought to be related to patient safety within the Pediatric Emergency Care Applied Research Network, (2) to measure staff perceptions of the climate of safety in EDs, and (3) to measure associations between ED characteristics and a climate of safety.

METHODS: Twenty-one EDs were surveyed to assess physical structure, staffing patterns, overcrowding, medication administration, teamwork, and methods for promoting patient safety. A validated survey on the climate of safety was administered to all emergency department staff members. Safety climate scores were compared to evaluate associations with ED characteristics.

RESULTS: A total of 1747 staff members (49%) responded to the survey on the climate of safety. A minority of EDs had organized safety activities such as safety committees (48%) or walk-rounds (38%), used computerized physician order entry (38%), had ED pharmacists (19%), or had formal physician/registered nurse teams (38%). The majority (67%) treated patients in hallways. Most (67%) varied staffing on the basis of seasonal patient volume. Of the 1747 ED staff members (49%) responding to the survey, there was a wide range (28%–82%) in the proportion reporting a positive safety climate. Physicians' ratings of the climate of safety were higher than nurses' ratings, and perceptions varied according to work experience. Characteristics associated with an improved climate of safety were a lack of ED overcrowding, a sick call back-up plan for physicians, and the presence of an ED safety committee.

CONCLUSIONS: Large variability existed among EDs in structures and processes thought to be associated with patient safety and in staff perception of the safety climate. Several ED characteristics were associated with a positive climate of safety.

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Key Words: pediatric patient safety • quality improvement • pediatric emergency care • health care quality

Abbreviations: ED—emergency department • PECARN—Pediatric Emergency Care Applied Research Network

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Accepted Nov 25, 2008.

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