“Small Things” make a Huge Difference in the Emergency Department

Background: The assessment of children in a busy mixed adult and paediatric emergency department (ED) can be challenging. Good support from the ED staff not only improves patient safety but also, renders care delivery less daunting.

Objective: To survey the clinical experiences of junior doctors in the resuscitation room and establish probable factors affecting patient safety before and after implementation of key recommendations.

Methods: An initial survey on the experiences of junior doctors during assessment of children in resus bays was conducted in October 2018. Some recommendations deduced were implemented; provision of sepsis trolley and grab box. A repeat survey in January 2019 was done to evaluate impact of implemented changes.

Results: Twenty doctors participated in the initial survey while 19 in the later survey. First survey was designated T1 and the repeat survey T2. All respondents reported attending at least 2 resuscitations in both surveys. Ten percent in T1 vs. 35% in T2 responded that a nurse was always present during resuscitation events. Ninety percent had performed or assisted in at least 1 procedure in the resuscitation bay in both surveys. Using a 5-point Likert scale, 40% of respondents in T1 vs. 63% in T2 were satisfied with the level of support of ED staff. Easy access to materials for resuscitation was rated good by 10% in T1 vs. 81% in T2. Over 70% in either survey requested resuscitation drugs; promptness of drug retrieval and administration was rated good by 13% (T1) vs. 45% (T2). The grab box was used by 65% in T2 with excellent feedbacks on its fall-back benefit.

Conclusion: Significant improvement was noted in care delivery following the implementation of the new sepsis trolley and grab box. There still exist areas for continued development in enhancing safe care delivery in this mixed adult and children ED.