Literature & Research


A Culture of Safety
In July 2008, The Joint Commission (TJC) issued a Sentinel Event Alert which discusses behaviors by members of the healthcare team that can compromise patient safety. Unfortunately, the identified behaviors are not uncommon in a number of emergency departments in America. Behaviors that Undermine a Culture of Safety are those behaviors that are intimidating and disruptive, including: verbal outbursts and physical threats; uncooperativeness; refusal to perform assigned tasks; refusal to answer questions; return calls or pages; condescending verbal interactions; and impatience. "Safety and quality of patient care is dependent on teamwork, communication, and a collaborative work environment. To assure quality and to promote a culture of safety, health organizations must address the problem of behaviors that threaten the performance of the health care team." In order to maintain accreditation, facilities must have in place by January of this year a new Leadership standard (LD.03.01.01) that states "the hospital/organization has a code of conduct that defines acceptable and disruptive and inappropriate behaviors" and "leaders create and implement a process of managing disruptive behaviors." The Sentinel Event Alert, along with providing root cause analysis of the issue, provides a number of suggested actions beginning with the education of all team members followed by holding all team members accountable for "modeling desirable behaviors."¹ Is your facility in compliance with this Joint Commission standard?

¹The Joint Commission. (2008). Sentinel Event Alert: Behavior that Undermines a Culture of Safety. Retrieved February 11, 2009 from http://www.jointcommission.org/SentinelEvents/SentinelEventAlert/sea_40.htm

National Report Card: Barely Passing
The American College of Emergency Physicians recently released the 2009 "National Report Card" which clearly identifies the dismal state of emergency care in many areas in the United States. While some states did very well, others did not and the overall score for the United States was a C-. Grades were assigned to each state based on five key target areas including: access to emergency care (D-); quality and patient safety environment (C+); medical liability environment (C-); public health and injury prevention (C); and disaster preparedness (C+).The scores were tallied based on 116 objective measures obtained from a variety of sources and can be viewed on an individual state basis. One of the areas evaluated as indicator of access to emergency care is the number of registered nurses per 100,000 people and the report reflected wide disparity from state to state. Arizona has the lowest number of registered nurses (560.8) per 100,000 people and the District of Columbia the highest (1385.2).

The category of access to emergency care received the poorest rating overall.¹

To most emergency nurses, the results come as no surprise - but that is to be expected because the report was not really written for professionals in the emergency arena. It was, in fact, written to "forcefully remind Americans - the general public, politicians, and decision makers - that the country's emergency medicine system remains perilously close to collapse in a number of states, and in critical condition elsewhere."<sup>2

1</sup>Epstein, S.K., Burstein, J.L., Case, R.B., Gardner, A.F., Herman, S.H. & et.al. (2009). The national report card on the state of emergency medicine: Evaluating the emergency care environment state by state 2009 edition. Annals of Emergency Medicine, 53(1), 4-148 http://www.emreportcard.org

²Berger, E. The 2009 ACEP report card, what it says, what it means and what it might accomplish. Annals of Emergency Medicine, 53(1), 7A-9A.

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