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Staffing Shortages No. 1 Challenge in Healthcare

(Editor's Note: This edition of ED Management is a special issue covering ongoing staffing shortages that are affecting EDs nationwide. In this single-topic issue, we report on the biggest challenges leaders are facing and offer solutions for operating safely, retaining staff, and mitigating legal risks.)

By Stacey Kusterbeck

Staffing shortages are the No. 1 challenge in healthcare, according to ECRI’s report, Top 10 Patient Safety Concerns 2022. For EDs facing staffing shortages, “the risks are widespread,” says Julye Johns Bailey, JD, a healthcare attorney in the Atlanta office of Huff Powell Bailey.

Short-staffed EDs mean patients have to wait longer for laboratory and diagnostic testing results. “There is also the need to keep patients in the ED for a longer period,” Bailey adds.

Taking longer to communicate test results can lead to a delay in diagnosis or treatment. “A delay in the ability to transfer patients to the floor or, in some cases, the ICU, means the patient will require monitoring while still in the ED, which will consume the resources of the ED staff,” Bailey says.

In turn, this can lead to more patients waiting to be seen and longer turnaround times generally. To avoid bad outcomes and litigation stemming from staffing shortages, Bailey says EDs should work with radiology to prioritize testing based on acuity levels. ED staff are accustomed to assigning acuity levels or Emergency Severity Index levels and assessing patients accordingly. “But other departments may see all requests from the ED as having the same sense of urgency,” Bailey notes.

Some radiology departments and laboratories treat all orders for ED patients as urgent. Those orders are prioritized on a first-come, first-served basis. It is up to the ED to make it clear which requests are the most urgent and really need to be handled first. An ED charge nurse can help communicate with other departments on how to prioritize patient testing.

“It prioritizes the patients with the highest acuity, leading to quicker diagnoses or treatment, which could prevent a bad outcome and, thus, prevent litigation,” Bailey explains. “The EP and the ED staff should document communications with other departments.”

For example, the emergency physician (EP) might chart: “Contacted radiology at 0100. Three other patients awaiting CT at this time. Radiology aware of order for CT for Ms. Smith.”

Considering the fact there are staffing shortages, there are going to be delays in testing. In those cases, says Bailey, “the documentation should be neutral, and should not blame any individual or even any specific department.”

7 Tips to Lower Risk When Short-Staffed

EDs operating short-staffed are not under any illusions that it is safe to do so. Instead, staff likely wonder: What should we be doing to mitigate risk? Beena Thomas, senior advisor on the risk solutions team at Raleigh, NC-based Curi Advisory, offers these recommendations:

• Develop a plan to communicate across the hospital if ED patient volume or wait times exceed what the staff can manage.

• Consider alternate staffing support tactics, such as using staff outside the ED to perform tasks that are within their competency and training.

• Consider job descriptions and roles, and which staff could be cross-trained.

• Assess the environment of care to improve line of sight or access to equipment and medications.

• Consider whether alarms are audible or visible.

• Train ED personnel in communication tactics to identify high-risk patients and improve communication about real-time safety concerns.

• Increase rounding by ED leaders and supervisors.