Impact of teamwork and communication training interventions on safety culture and patient safety in emergency departments: a systematic review

© 2020 Lippincott Williams & Wilkins, Inc. This is a non-final version of an article published in final form in Journal of Patient Safety, available at: https://dx.doi.org/10.1097/PTS.0000000000000782.Objectives: To narratively summaries literature reporting on the effect of teamwork and communication training interventions on culture and patient safety in emergency department (ED) settings. Methods: We searched PubMed, EMBASE, Psych Info CINAHL, Cochrane, Science Citation Inc, Web of Science, and Educational Resources Information Centre for peer-reviewed journal articles published from January 1, 1988, until June 8, 2018 that assessed teamwork and communication interventions focusing on how they influence patient safety in the ED were selected. One additional search update was performed in July 2019. Results: Sixteen studies were included from 8,700 screened publications. The studies’ design, interventions, and evaluation methods varied widely. The most impactful ED training interventions were End-of-Course Critique, TeamSTEPPS, and crisis resource management (CRM)-based training. CRM and TeamSTEPPS CRM-based training curriculum were used in most of the studies. Multiple tools, including the Kirkpatrick (KP) evaluation model, Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture, TeamSTEPPS Teamwork Attitudes Questionnaire, the Safety Attitudes Questionnaire, and the Communication and Teamwork Skills Assessment were used to assess the impact of such interventions. Improvements in one of the domains of safety culture and related domains were found in all studies. Four empirical studies established improvements in patient health outcomes that occurred following simulation CRM training (KP4), but there was no effect on mortality. Conclusion: Overall, teamwork and communication training interventions improve the safety culture in ED settings and may positively affect patient outcome. The implementation of safety culture programs may be considered to reduce incidence of medical errors and adverse events.Peer reviewe

Length-of-Stay in the Emergency Department and In-Hospital Mortality: A Systematic Review and Meta-Analysis

The effect of emergency department (ED) length of stay (EDLOS) on in-hospital mortality (IHM) remains unclear. The aim of this systematic review and meta-analysis was to determine the association between EDLOS and IHM. We searched the PubMed, Medline, Embase, Web of Science, Cochrane Controlled Register of Trials, CINAHL, PsycInfo, and Scopus databases from their inception until 14–15 January 2022. We included studies reporting the association between EDLOS and IHM. A total of 11,337 references were identified, and 52 studies (total of 1,718,518 ED patients) were included in the systematic review and 33 in the meta-analysis. A statistically significant association between EDLOS and IHM was observed for EDLOS over 24 h in patients admitted to an intensive care unit (ICU) (OR = 1.396, 95% confidence interval [CI]: 1.147 to 1.701; p 2 = 0%) and for low EDLOS in non-ICU-admitted patients (OR = 0.583, 95% CI: 0.453 to 0.745; p 2 = 0%). No associations were detected for the other cut-offs. Our findings suggest that there is an association between IHM low EDLOS and EDLOS exceeding 24 h and IHM. Long stays in the ED should not be allowed and special attention should be given to patients admitted after a short stay in the ED