Understaffed and overcrowded: survey highlights ED safety fears

Dr Said Hachimi-Idrissi

Provisional findings of the survey, which is still in progress, were presented at the EUSEM 2023 congress in Barcelona by Dr Said Hachimi-Idrissi in a session which also focused on how technology can impact safety and quality within the ED. During his presentation, he admitted that the scenario was complex with no clear solutions. ‘The objective of the survey is to get an insight on Quality and Safety programme initiatives across Europe and more specifically in emergency departments and/or in Pre-Hospital EM settings,’ added Dr Hachimi-Idrissi, who is Clinical Chief of the Emergency Department (ED) at UZ Ghent in Belgium. 

More than a matter of mere discomfort

A key finding of the survey so far is that about 90% of professionals feel that at times the number of patients in their ED exceeds the capacity of the department to provide safe care and that overcrowding is a regular and serious problem. Dr Hachimi-Idrissi added: ‘Overcrowding is not just an issue of discomfort or loss of dignity, but carries a substantial risk of harm and increased mortality. Understaffing was another major contributory factor.’ 

He said there are far too few doctors for the volume and complexity of many of the patients. This increases the risk of harm to the patient, and of morbidity and mortality, when the length of stay at the ED is too long. In addition, this imbalance is imposing stress, which may result in burnout, practitioners leaving the profession, impacting relationships and use of illicit substances. The expert hopes the survey findings help lead to changes in emergency care practice, increase awareness of the risk, and mitigate and tackle that risk to deliver improvements. Administrators, nurses, physicians, and patients all have a role to play in achieving that, he added, naming development of clinical interventions to reduce adverse events, better monitoring, the use of KPI (key performance indicators) and benchmarking as viable option to move towards this goal.

AI: a new hope for the ED?

Technology could also have a role to play in making more efficient use of time in the ED and impact positively on quality and safety, such as use of Artificial Intelligence (AI) tools. ‘AI and machine learning would help to monitor patients and integrate data, vital signs and symptoms to define the population at risk, though more research in this area is needed,’ Dr Hachimi-Idrissi said. However, he remains concerned that the current environment in EDs across Europe is a health hazard for patients and healthcare providers. 

The session also included presentations looking at how hi-tech can catch impact positively on quality and safety in the ED; the use of big database and AI on continuous quality and safety improvement in emergency medicine; and how to integrate patient satisfaction in big databases to improve performances in the ED. 

In a separate EUSEM session, findings were presented from a study that indicate the AI chatbot ChatGPT performed as well as trained doctors in suggesting likely diagnoses for patients being assessed in the ED. While researchers at Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands acknowledge that more work is needed, their findings suggest the technology could support doctors working in emergency medicine, potentially leading to shorter waiting times for patients. 

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Dr Said Hachimi-Idrissi is Clinical Chief of the Emergency Department at the University Hospital (UZ) Ghent in Belgium and Professor of Critical Care Medicine at the University of Ghent as well as Professor at the Free University Brussels. A Past President of the Belgian Society of Emergency and Disaster Medicine, he is Director of the Global Network on Emergency Medicine, a council member of the paediatric section of the EuSEM and has published extensively in peer-reviewed international publications.

05.11.2024

• emergency medicine (307)
• staff management (247)