Evaluating an emergency department checklist to improve patient safety and care

Emergency departments (EDs) in hospitals are busier than ever. If an emergency department is crowded and ambulances can’t drop off patients, there can be long delays in very sick people seeing a doctor.

Overcrowding makes it difficult for emergency department staff to care for patients as well as they would like to and can result in patients not receiving the attention they need at the right time. Doctors and nurses can become overwhelmed by the tasks they need to complete to take care of their patients.

A checklist of what should be done each hour for every patient coming into the department has been introduced in the west of England region in response to this situation. It aims to keep patients safe and help hospital staff to keep track of the care each patient needs.

CLAHRC West has been working with West of England Academic Health Science Network (AHSN) to examine the effectiveness of this checklist in five hospitals in the region.

Unless they are already using an equivalent evidence-based system, hospitals trusts are now being encouraged by NHS Improvement to use both this ED Safety Checklist and the supporting toolkit.

Use of the checklist (or an equivalent) is now supported and endorsed by NHS Improvement, NHS England, the Royal College of Emergency Medicine, the Royal College of Nursing and the Care Quality Commission.

We’re still working on our evaluation and will share the full report later in 2017. But we have identified some early lessons for implementing and using the checklist. We would be very happy to discuss these with NHS trusts that are planning to use the checklist.

If you want to discuss implementation with us, please get in touch at clahrcwest@nihr.ac.uk.

Project aims

The study has two parts. The first part involves comparing key performance indicators (KPIs) during the year before and the year after the implementation of the checklist. This analysis will include five emergency departments and aims to investigate whether introducing the checklist has had any effect on how often KPIs are met.

The second stage involves researchers from CLAHRC West going into two of the hospitals to see how the checklist is used and to speak to doctors, nurses and other healthcare workers about their experiences of using it. Our aim is to understand how the checklist is used by health care professionals: how it affects their working practices and whether it makes caring for patients in emergency departments easier.

CLAHRC West will discuss our research with a panel of public volunteers. This panel will offer their point of view on what the checklist achieves, what the results from the study mean to the public and what matters most about it.

Anticipated impacts

If this evaluation shows that the emergency department checklist is effective at improving patient safety and care, other regions may consider adopting this approach. It will help other areas implement the emergency department checklist by investigating what has helped or hindered the roll-out in the participating hospitals.

CLAHRC West staff

Tracey Stone

Dr Tracey Stone

Katie Warner

  • Project Support Officer
  • Evaluation
  • Management and administration
Lauren Scott

Lauren Scott

Partners on this project

University Hospitals Bristol NHS Foundation Trust

University Hospitals Bristol NHS Foundation Trust is a dynamic group of hospitals in the heart of Bristol, with over 100 clinical services across nine sites. They offer care to the people of Bristol and the South West, and have an international reputation for cardiac surgery, paediatric services, oncology and bone marrow transplantation and are the largest centre for medical training and research in the South West.

University of the West of England (UWE Bristol)

UWE Bristol is one of Britain's largest universities with a consistent reputation for high graduate employment, quality in teaching and growth in research. It is at the heart of dynamic partnerships that deliver real impact in the world. UWE hosts the Bristol Robotics Laboratory, the largest academic centre for multi-disciplinary robotics research in the UK.

West of England Academic Health Science Network

The West of England Academic Health Science Network is a diverse network of partners working collaboratively to put innovation at the heart of healthcare, to improve patient outcomes and contribute to wealth creation. It aims to do this by translating research into practice, and developing and implementing integrated health care services.