Link between clinical errors and emergency shift patterns

Grant ID: EMSS-318R26-2016

Project Summary

There is a well-established link between shift work, nurse exhaustion and clinical errors. However there is a lack of research focusing specifically on emergency departments (ED) and nurse rostering patterns.

ED nurses are at particular risk of fatigue due to the fast-paced and demanding nature of the work environment caring for high acuity patients, increasing the risk of clinical errors and threatening patient safety. Shift work in the ED is an around-the-clock occupation, frequently nurses are required to commence work at 07:00 on the morning following a 21:30 finish, a shift pattern termed a “late/early”. Understanding the impact that this shift pattern may have in adverse clinical events is critical for patient and staff well-being.

This novel project will collect and analyse retrospective data from the ED at Nambour General Hospital to ascertain whether late/earlies are associated with adverse patient outcomes. We will use a logistic regression model to analyse data collected from PRIME (electronic database for clinical incident reporting), TrendCare (online nurse rostering system), EDIS (Emergency Department Information System) and patient medical records. This analysis will allow us to identify any association between clinical incident severity rating, patient outcomes, time of the incident, staff roster patterns and level of nursing experience.

The results of this study will therefore provide significant insights into the relationship between ED nurse shift patterns and adverse clinical events. The outcomes of this research may be used to assist and improve rostering practices, fatigue management, staff well being, and improve patient safety outcomes.

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Outcomes

With a total of n=244 clinical incidents (CI) and n=1095 ED nursing shifts analysed, no significant relationship between the CI and nursing shift patterns was identified, despite there being an association between nursing shifts and fatigue. The study found ED length of stay (LOS) was significantly higher for a patient presentation when a CI occurred. Future studies are recommended to investigate CIs including the impact between fatiguing nursing shift patterns, extended LOS and overcrowding in ED.

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Leveraged Funds

- $10,000 - Wishlist Research Grant Scheme - Ms Kym Roberts and Dr Ogilvie Thom

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Dissemination

Publication:

- Roberts, K., Thom, O., Hocking, J., Bernard, A., & Doyle, T. (2022). Clinical incidents in the emergency department: is there an association with emergency nursing shift patterns? A retrospective observational study. BMJ Open Quality, 11(3), e001785.

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