Development of an Emergency Department Safety Checklist through a global consensus process

Abstract

Emergency departments (EDs) are at high risk for medical errors. Checklist implementation programs have been associated with improved patient outcomes in other high-risk clinical settings and when used to address specific aspects of ED care. The aim of this study was to develop an ED Safety Checklist with broad applicability across different international ED settings. A three-round modified Delphi consensus process was conducted with a multidisciplinary and multinational panel of experts in emergency medicine and patient safety. Initial checklist items were identified through a systematic review of the literature. Each item was evaluated for inclusion in the final checklist during two rounds of web-based surveys and an online consensus meeting. Agreement for inclusion was defined a priori with a threshold of 80% combined agreement. Eighty panel members from 34 countries across all seven world regions participated in the study, with comparable representation from low- and middle-income and high-income countries. The final checklist contains 86 items divided into: (1) a general ED Safety Checklist focused on diagnostic evaluation, patient reassessment, and disposition and (2) five domain-specific ED Safety Checklists focused on handoff, invasive procedures, triage, treatment prescription, and treatment administration. The checklist includes key clinical tasks to prevent medical errors, as well as items to improve communication among ED team members and with patients and their families. This novel ED Safety Checklist defines the essential elements of high-quality ED care and has the potential to ensure their consistent implementation worldwide.

Keywords: Checklist; Delphi technique; Emergency department; Medical errors; Patient safety; Quality of health care.

Fig. 1

Consensus development process flowchart. Summary of the modified three-round Delphi process. Initial checklist items were identified by the core study team through a systematic review of the literature on medical errors in the emergency department

Fig. 2

General Emergency Department Safety Checklist

Fig. 3

Domain-specific Emergency Department Safety Checklists

Fig. 4

Patient flow through the emergency department. Infographic describing the patient flow from arrival in the Emergency Department (ED) through discharge or admission to the hospital. The general ED Safety Checklist is designed for use at three critical junctures (indicated by the stop signal) where the clinician can pause to verify that all important tasks have been completed. The five domain-specific Safety Checklists complement the general checklist by aiding clinicians during other key moments in the ED care process (colored in red)