Emergency Physician Perceptions of Patient Safety Risks

Study objective: Although national standards to address patient safety exist, their relevance to emergency department (ED) patient safety is unclear. We survey practicing emergency physicians to assess their perceptions of the relative importance of patient safety concerns and how these varied by urban/rural location and practice characteristics. Methods: We developed and analyzed electronically collected survey data that assessed emergency physician perceptions of patient safety risks. American College of Emergency Physicians (ACEP) members rated 16 patient safety concerns with a 5-point Likert scale. Results: Of 2,507 emergency physician respondents, 1,114 (44%) practiced in urban, 1,056 (42%) in suburban, and 337 (13%) in rural settings. Crowding from inpatient boarding (mean Likert scale score 4.3), availability of specialty consultation (mean 4.1), and nursing shortages (mean 3.9) were the greatest concerns. Rural respondents ranked consultant availability (mean 4.3), lack of follow-up after ED care (mean 3.8), and nurse shortages (mean 3.8) as top concerns. Crowding was the greatest concern for suburban (mean 4.3) and urban emergency physicians (mean 4.5) but was ranked seventh by rural emergency physicians (mean 3.5). Crowding was perceived as a greater problem as hospital size, ED volume, and the percentage of patients who left without being seen increased, regardless of practice location. Conclusion: In this sample of practicing emergency physicians, rural emergency physicians' patient safety concerns differ from those of their urban/suburban counterparts. For urban/suburban emergency physicians, crowding is the greatest safety concern; for rural emergency physicians, consultant availability was the greatest concern. Emergency physicians' greatest concerns are not routinely measured and reported as part of national patient safety benchmarking programs.